Infectious Disease
The COVID-19 pandemic triggered “significant” drug changes in patients with rheumatoid arthritis
April 20, 2021
3 min read
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The researchers report funding from Pfizer. Michaud does not report any other relevant financial information. Co-author Ekta Agarwal, MPH, reports on a job at Pfizer.
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Rheumatoid arthritis patients in the United States made “significant” changes to medication with and without medical guidance during the first three months of the COVID-19 pandemic. This is evident from data published in Arthritis Care & Research.
“A great deal of information about COVID-19 was leaked to the public in the first few weeks of the US pandemic, and much of it was later exposed as misinformation.” Kaleb Michaud, PhD, of FORWARD, the National Rheumatic Disease Database based in Wichita, Kansas, and the University of Nebraska Medical Center reported to Healio Rheumatology. “Yet the process of science – understanding, testing, and discovering – was observed in real time.”
“Recommendations at a time of confusion and misinformation can be extremely helpful to our patients and our providers, and this is an example of this effective dissemination,” said Dr. Kaleb Michaud versus Healio Rheumatology. Data derived from Michaud K, et al. Arthritis Care Res. 2021; doi: 10.1002 / acr.24611.
“As a result, many people with autoimmune rheumatic diseases like rheumatoid arthritis decided what to do based on the news, and not with their rheumatologist or doctor,” he added. “Many medical appointments were canceled and most doctors did not know how best to proceed. That is why the American College of Rheumatology’s initial recommendations on April 13, 2020 were such an important first step in treating and changing medication. “
To analyze changes in medication, lifestyle and clinical care for patients with RA during the first three months of the COVID-19 pandemic in the United States, Michaud and colleagues examined data from the FORWARD observational registry. In addition to their regular biannual questionnaires, registration participants were invited by email between March 25, 2020 and June 2, 2020 to complete up to five additional COVID-19 questionnaires.
Caleb Michaud
For their own study, Michaud and colleagues focused on adult patients with RA who completed at least one semi-annual questionnaire between January 2018 and January 2020 and at least one COVID-19 questionnaire administered in May 2020 and June 2020. They also limited their inclusion criteria for patients receiving either hydroxychloroquine, another conventional synthetic disease-modifying anti-inflammatory drug, a biological DMARD with TNF inhibitor, a biological DMARD without TNF inhibitor, a JAK inhibitor, NSAIDs, or glucocorticoids.
In total, Michaud and colleagues included 734 patients in their analysis. They compared drug changes based on DMARD exposure using logistic models that took into account age, gender, comorbidities, education, health insurance, RA activity, fatigue, and polysymptomatic stress.
According to the researchers, 30.1% of enrolled patients reported changes in medication. Of those who changed their medication, 33% were using glucocorticoids before the COVID-19 pandemic, compared with 18% of those who stayed on their treatment. Meanwhile, those who switched medications were less likely to use conventional DMARDs without COVID-19 without hydroxychloroquine – 49% compared to 62% of those who stayed on the same treatment. Patients who switched medications reported greater economic hardship during the pandemic – 23% versus 15%.
Although the use of JAK inhibitors was associated with a change in treatment (OR = 1.9; 95% CI, 1-3.4), in multivariable models only the use of glucocorticoid prior to the pandemic remained a strong predictor (OR = 3; 95% CI, 1.9-4.9). In the meantime, changes in care were significant with lung diseases (OR = 2.9; 95% CI, 1.3-6.5), poorer RA activity (OR = 1.1; 95% CI, 1-1, 1) and glucocorticoid consumption (OR = 1.6; 95) related% CI, 1-2.5).
The overall incidence of treatment change was the same before and after the ACR guidelines were published. However, self-imposed changes were roughly twice as likely before they were published, while physician-led changes were more likely afterwards.
“We have shown quantitatively that the situation described above, which was mainly discussed in news articles and editorials, was quite correct,” said Michaud. “We have also shown that comorbid lung disease and the use of glucocorticoids are the most important factors in changing DMARD medications, likely based on early reports of infection risks and complications. We had already reported problems related to obtaining HCQ access for some of our participants in March 2020. “
“It was also interesting to see how behavior changed with regard to DMARDs that were soon to be tested in randomized clinical trials for the treatment of more advanced COVID-19,” he added. “Even if some are now approved for the treatment of RA and COVID-19, it will be interesting to see the inclusion or any changes to these DMARDs. Recommendations at a time of confusion and misinformation can be extremely helpful to our patients and providers, and this is an example of this effective dissemination. “
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