DMARD interruptions rose 80% in early 2021 among autoimmune rheumatic patients
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DMARD interruptions in patients with autoimmune rheumatic diseases increased more than 80% between December 2020 and May 2021, leading to higher rates of self-reported flares, according to data published in Arthritis Care & Research.
“The COVID-19 pandemic has been a particular concern for patients with autoimmune rheumatic diseases (ARDs), who are known to be at a higher risk for infections due to their autoimmune conditions, comorbidities, and use of immunosuppressive therapies,” Tiffany Dharia, MD, of the University of Pennsylvania, in Philadelphia, and colleagues wrote. “Despite ongoing research, the risk of severe COVID-19 due to use of different immunosuppressive therapies remains uncertain. The impact of immunosuppressive therapies on vaccination response has also emerged as a concern for patients with ARDs.”
“Prior studies have shown that patients with ARDs had frequent healthcare disruptions and interruptions in use of their disease modifying anti-rheumatic drugs (DMARDs) early in the COVID-19 pandemic,” they added. “Little is known, however, about how these disruptions affected patient health or how patient concerns and behaviors changed over time.”
To analyze trends in anxiety and DMARD interruptions among patients with rheumatic disease during the COVID-19 pandemic, and to determine whether treatment interruptions were associated with disease flares, Dharia and colleagues studied longitudinal data from an online registry.
Participants included adults in the ArthritisPower and Vasculitis Patient Powered Research Network, the CreakyJoints patient community and partnering patient organizations, including the Vasculitis Foundation, the Relapsing Polychondritis Foundation, American Bone Health, the Lupus and Allied Diseases Association, Myositis Support and Understanding, and the International Foundation for Autoimmune and Autoinflammatory Arthritis. Patients were invited via email to complete a series of online surveys. These surveys were conducted at baseline, weeks 2, 4, 6 and 8, and then monthly until week 28, followed by two more at weeks 38 and 52.
The surveys collected demographic data as well as information on diseases, comorbidities, medications, respiratory illness, COVID-19 testing and diagnoses, use and availability of telemedicine, current DMARD use, DMARD interruptions due to COVID-19 concerns, and anxiety during the previous week based on the four-question PROMIS Anxiety short form. Participants were also asked if they were experiencing disease flare and, if so, to rate its severity on a scale of zero to 10. Severe flare was defined as a six or greater.
For this analysis, Dharia and colleagues included results from 2,424 participants who completed baseline surveys between March 29, 2020, and June 30, 2020, and at least one follow-up survey through May 2021. The participants included in the analysis ultimately completed a median of five follow-up surveys. The most common diseases among this population were rheumatoid arthritis, vasculitis and psoriatic arthritis.
According to the researchers, average PROMIS-Anxiety T-scores decreased from 58.7 in April 2020 to 53.7 in May 2021 (P < .001). DMARD interruptions also decreased, from 11.2% to 7.5%, from April 2020 to December 2020 (P < .001). However, these interruptions later increased substantially to 14% through May 2021 (P < .001).
After adjusting for demographics, medications, disease and calendar time, DMARD interruptions were associated with a significant increase in severe flare at the following survey (OR = 1.71; 95% CI, 1.23-2.36), but not in any flare (OR = 1.18; 95% CI, 0.89-1.58).
“Medication interruptions can have a substantial effect on patient health and contribute to severe disease flares,” Dharia told Healio Rheumatology. “We also noted that those who had higher anxiety were more likely to report stopping their medication.”
“Prolonged interruptions in medications are likely to lead to severe disease flares, as shown in our study,” she added. “Longer interruptions, however, are likely quite different from short 1- to 2-week interruptions around the time of vaccination, if indicated. It is critical for patients to continue discussions with their rheumatologist regarding which medications they should continue, and which may be necessary to stop, knowing that holding medications may have severe adverse effects.”
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