medwireNews: Patients with rheumatic diseases have reported issues with access to methotrexate following changes to abortion laws, show findings from a questionnaire study conducted in the USA.
“In high doses, methotrexate can be used to treat miscarriage and ectopic pregnancy,” explained Kristin Wipfler (The National Databank for Rheumatic Diseases, Wichita, Kansas) in a poster presentation at ACR Convergence 2022 in Philadelphia, Pennsylvania, USA.
She said that there have been some reports of rheumatology patients experiencing barriers to care following the US Supreme Court’s decision to overturn Roe versus Wade in June 2022, but “the scope and severity of this issue is unknown.”
To investigate further, the team analyzed data from 1706 people (mean age 67.2 years, 84.6% women) with rheumatic diseases – most commonly rheumatoid arthritis (67.2%), osteoarthritis (12.5%), or systemic lupus erythematosus (5.3%) – who responded to a survey on medication access since June 24, 2022. A total of 42.5% of respondents resided in states with legal or protected abortion status, while 32.2% were in states categorized as “hostile/at-risk” and 25.3% were in states where abortion is banned or severely restricted. Most participants were White (93.3%), with an average 15.2 years of education.
In all, 396 patients said they had attempted to fill a prescription for methotrexate during the study period, and 5.8% of these individuals, all of whom were women, reported barriers to access. One additional patient reported restricted access to hydroxychloroquine.
Of the 24 respondents experiencing medication access issues, the majority (62.5%) said this was due to delays with the pharmacy filling the prescription, while 12.5% said that pharmacists asked “excessive questions” about pregnancy.
The team then sent follow-up requests to participants who reported problems. Of the 11 people responding to the follow-up, five said they were told that their issues with medication access were due to pregnancy risk or concerns related to the Supreme Court’s decision on abortion, while six that that there was “no clear explanation” for delays or refusals, said Wipfler.
“It’s very important to note that respondents to this survey were predominantly highly educated, White, and older than childbearing age and still experienced this level of impact,” she stressed.
“The impact in higher risk populations is expected to be more severe.”
The presenter concluded: “Because most issues experienced were delays by pharmacies in seeking to confirm the purpose of the prescription, we recommend that healthcare providers prescribing abortifacient medications include the patient’s rheumatic diagnosis on the prescription to reduce or avoid delays.”
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ACR Convergence 2022; Philadelphia, Pennsylvania, USA: November 10–14