DMARD interruptions in rheumatic disease persist despite reduced COVID-related anxiety
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Despite a significant decrease in anxiety related to COVID-19, patients with autoimmune rheumatic disease continue to experience frequent interruptions in their medication use, according to survey data presented at ACR Convergence 2021.
“We previously had found that many patients had their health care interrupted early in the pandemic and that patients frequently had stopped medications because of COVID-19 concerns,” Michael George, MD, MCSE, assistant professor of medicine and assistant professor of epidemiology in biostatistics and epidemiology at the Hospital of the University of Pennsylvania, and a medical advisor to CreakyJoints, told Healio Rheumatology.
“We wanted to see how these things changed over the course of the pandemic and also to look at the impacts on patient health by examining disease flares,” he added. “We know in general that if patients have long interruptions in their medications that this can lead to disease flares, but we had no information on how the interruptions in DMARD use caused by the pandemic were affecting patient health.”
To analyze trends in medication interruptions, as well as feelings of anxiety, during the COVID-19 pandemic, and examine whether said interruptions were linked to an increase in disease flare, George and colleagues surveyed patients from the ArthritisPower and Vasculitis Patient Powered Research Network registries. Participants with autoimmune rheumatic disease were invited to complete a baseline questionnaire followed by additional surveys every 2 weeks until week 8, and subsequently every month until week 28, with a final survey at week 38.
The researchers included participants who completed baseline surveys between March 29 and June 30, 20202, as well as at least one follow-up survey, which were obtained through February 2021. A total of 2,396 patients — completing a median of six surveys — were analyzed. Among the participants, the most common autoimmune rheumatic diseases were rheumatoid arthritis, vasculitis and psoriatic arthritis.
George and colleagues assessed changes in PROMIS Anxiety T-scores and medication interruptions due to COVID-19 concerns — measured among patients receiving DMARDs — over time using generalized estimating equation (GEE) models to account for within-person correlations. The researchers also used GEE models to analyze links between drug interruptions and self-reported disease flares at the next survey among patients using DMARDs who were not currently experiencing flare, adjusting for demographics, medication type, disease type and calendar time.
According to the researchers, average PROMIS-Anxiety T scores decreased significantly from 59 in April 2020 to 55.6 in February 2021 (P < .001), while drug interruptions decreased significantly from 11.2% in April to 7.5% in December 2020 (P < .001). However, medication interruptions increased to 13.5% in February 2021 (P = .001 versus December 2020).
Drug interruptions were more common in patients with higher anxiety (P < .001), occurring in 10.5% of those with a PROMIS-Anxiety T-score of at least 60, compared with 7.8% in those with a score of less than 60.
A total of 1,419 patients — providing 5,270 total responses — had at least one survey response during which they were using DMARDs and did not report a current flare. Among these patients, 15.9% reported any flare and 8.7% reported a severe flare at the next survey. Medication interruptions were associated with a significant increased risk for severe flare (OR = 1.76; 95% CI, 1.24-2.48).
“Patient anxiety was substantially lower in 2021, but we did find more interruptions in DMARD use,” George said. “These interruptions were less commonly due to concerns about getting sick with COVID, and we suspect that some patients were stopping medications because of concerns about how medications might impact vaccine efficacy. Some of these interruptions may have been appropriate, but others likely were not, especially since they were often not directed by a physician.”
“Interruptions in medication use remain common and can have a substantial impact on patient health,” he added. “We need to communicate proactively with patients to help prevent unnecessary medication interruptions both during this pandemic and in future public health crises, especially since patients who have lost touch with their provider might be at the highest risk for medication interruptions.”
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Dharia T. Abstract 1598. Presented at: ACR Convergence 2021; Nov. 5-9, 2021 (virtual meeting).
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