Rheumatology patients report 'substantial' treatment changes during height of COVID-19
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The height of the COVID-19 pandemic in New York caused “substantial” medication changes for rheumatology patients in order to minimize infection risk and potential harm, according to findings published in Arthritis Care & Research.
“Despite possible infection, standard rheumatologic guidelines recommend maintaining an established medication regimen when rheumatic conditions are stable,” Carol A. Mancuso, MD, of the Hospital for Special Surgery, and colleagues wrote. “Challenges arise, however, when flares develop during an at-risk period, such as during the COVID-19 pandemic. Such periodic fluctuations in symptoms may be common under the best of circumstances but are more prevalent and severe during times of increased physical and psychological stress.”
“To date there is limited information about the impact of COVID-19 on patients’ experiences with their medications for systemic rheumatic disease,” they added. “Preliminary reports indicate that altering medications may not be uncommon. The effects of decreased or sub-optional medication dosing in other scenarios, such as intentional cessation and non-adherence, generally have shown unfavorable outcomes.”
To examine patient perspectives regarding changes to their necessary medications and regimens during the height of the COVID-19 pandemic in New York, Mancuso and colleagues recruited and interviewed 112 patients of 13 rheumatologists at the Hospital for Special Surgery. According to the researchers, enrollment began April 2, when both incidence and death rates from COVID-19 demonstrated continuous increase in the city, and ended April 21, after several consecutive days of rate decreases.
All participants had been diagnosed by a physician with a rheumatic disease — 30% with lupus, 26% with rheumatoid arthritis and 44% with various other conditions — and prescribed DMARDs. Interviews were conducted via telephone and included open-ended questions regarding the impact of COVID-19 on their medications. The researchers used content and thematic analyses to organize responses into categories that described patterns of medication changes.
According to the researchers, patterns that emerged from the interviews included the increased or decreased risk for COVID-19 infection, the use of hydroxychloroquine, maintaining treatment status quo, the role of glucocorticoids, increasing or decreasing existing medications in relation to clinical disease activity, postponing infusions, and developing a treatment plan in the event of COVID-19 infection. Among the medication changes reported by patients, some were “suboptimal” for disease control, Mancuso and colleagues wrote. However, these changes were made to limit the risk for infection and to minimize the potential harm due to physicians being unable to obtain laboratory tests and face-to-face physical examinations.
“We learned that during this most uncertain time, patients and their rheumatologists made substantial modifications to essential medications that, in some cases, were temporizing measures and deviations from planned regimens,” Mancuso and colleagues wrote. “These modifications occurred to minimize both infection risk and potential harm from not being able to monitor clinical status with physical examinations and laboratory tests. The near- and long-term sequelae of these modifications and deviations will be assessed in longitudinal follow-ups.”
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