US patients with RA substantially changed medication in response to COVID-19
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Patients in the United States with rheumatoid arthritis made substantial changes to their medication use in the first 3 months of the COVID-19 pandemic, according to a speaker at ACR Convergence 2020.
“We took a look at all those who had medication changes versus those who didn’t during this 3-month period, as we already published in April that there was a major disruption in March and the early days of the COVID-19 pandemic in the U.S.,” Kaleb Michaud, PhD, an associate professor at the University of Nebraska Medical Center, said in a recorded poster presentation for the virtual meeting.
To analyze care and treatment changes among patients with RA during March through May of the COVID-19 pandemic in the United States, Michaud and colleagues studied data from the FORWARD observational registry. The researchers examined data from adults with RA who provided baseline characteristics and medication use for 2019 and later answered the registry’s COVID-19 web-based surveys in May and June. A total of 734 respondents were included in the study.
The researchers compared medication changes from pre-COVID-19 use of disease-modifying antirheumatic drugs through logistic models, both with and without adjusting for age, sex, comorbidities, education, health, insurance, RA activity, fatigue and polysymptomatic distress. Comorbidities included pulmonary and cardiovascular diseases. Michaud and colleagues also assessed rates of medication change before and after the first COVID-19 ACR treatment guidelines were released in April.
According to the researchers, 30% of included patients reported medication changes. Those who changed their medication use were more likely to receive glucocorticoids — 33% compared with 18% — and less likely to use non-hydroxychloroquine conventional synthetic DMARDs — 49% compared with 62% — prior to the pandemic. While JAK inhibitor use was associated with change in bivariate analyses (OR = 1.9; 95% CI, 1-3.4), only glucocorticoids remained as a strong factor in multivariable models (OR = 3; 95% CI, 1.9-4.9).
Treatment change was most associated with pulmonary disease (OR = 2.9; 95% CI, 1.3-6.5) and glucocorticoid use (OR = 1.6; 95% CI, 1-2.5). In addition, although the incidence of medication changes before and after April 15 was the same, patient-initiated changes due to COVID-19 were twice as likely before April 15, while physician-guided changes were more likely made after.
“Overall, medication changes were much more common in those participants who reported taking glucocorticoid steroids, more DMARDs in general, had worse disease activity and had a fear of COVID-19 in general,” Michaud concluded.
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Michaud K. Abstract L05. Presented at: ACR Convergence 2020; November 5-9, 2020 (virtual meeting).
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