medwireNews: Findings from two questionnaire studies suggest that a substantial proportion of rheumatology patients have experienced changes to their disease management since the emergence of COVID-19.
In the first study, published as a correspondence article in the Annals of the Rheumatic Diseases, Vikas Agarwal (Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India) and colleagues found that of 221 members of the Indian Rheumatology Association who responded to a survey on COVID-19 (of a total 861 invitees), almost half (47.5%) reported a reduction in the usage of biologic DMARDs among their patients, while 12.2% reported a drop in conventional DMARD use.
A total of 64.2% of the healthcare providers said they were less inclined to change a patient’s major immunosuppressant for impending flare than they were before the emergence of COVID-19; the most frequently deferred treatment was rituximab, followed by cyclophosphamide, tumor necrosis factor inhibitors, Janus kinase inhibitors, and other biologics.
Approximately two-thirds of respondents said they were more inclined to initiate hydroxychloroquine as an antirheumatic drug in patients with borderline indications than they were previously, while the majority (81.9%) favored hydroxychloroquine when asked which drug would work for the treatment of COVID-19.
“This may be attributed to its safety profile, greater in vitro efficacy against covid-19 and greater experience with [hydroxychloroquine] as rheumatologists,” but “caution is needed as reports of toxicity have emerged with the use of prophylaxis,” say Agarwal and colleagues.
The researchers say that their findings represent “the viewpoint of a large number of rheumatologists and could shape future evidence-based opinions on managing patients with [immunosuppressants] during the covid-19 pandemic.”
For the second study, 7061 patients with rheumatic diseases from the FORWARD registry were sent a COVID-19 questionnaire, of whom 7.5% responded. The majority of the 530 respondents had a primary diagnosis of rheumatoid arthritis, at 60.6%, while 11.1% had osteoarthritis, 5.7% systemic lupus erythematosus, and 22.6% other rheumatic diseases.
In all, 11 of the respondents met COVID-19 testing criteria, and three received testing, but none tested positive for severe acute respiratory syndrome coronavirus-2.
Kaleb Michaud (University of Nebraska Medical Center, Omaha, USA) and co-researchers say that 42% of participants reported a change to their healthcare in the previous 2 weeks. Of these 197 people, 48% reported canceled or postponed appointments, 24% a switch to telemedicine, 14% self-imposed medication changes, 11% physician-directed medication changes, 10% being unable to obtain medication, and 4% being unable to reach their rheumatologist.
“It’s important for clinicians to be aware that some patients have stopped taking their medications without recommendation from a health professional,” say the researchers in ACR Open Rheumatology.
Noting that some patients were unable to obtain their medication due to hydroxychloroquine shortage, they conclude: “As evidence accumulates on the effectiveness of potential COVID-19 treatments, many of which are used in treating rheumatic diseases, effort is needed to ensure continued access to treatments that have already been proven effective for rheumatic diseases.”
medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group
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Ann Rheum Dis 2020; doi:10.1136/annrheumdis-2020-217509
ACR Open Rheumatol 2020; doi:10.1002/acr2.11148