High Treatment Adherence in Patients With Rheumatic Disease During COVID-19

Adherence to treatment regimen remained high in patients with rheumatic disease during the early stages of the COVID-19 pandemic, according to a study published in Advances in Rheumatology.¹ However, as this is a high-risk group and patients with long-term illnesses were more likely to stop treatment, investigators urge rheumatologists to closely monitor their patients during this time.

“Patients with rheumatic diseases have an inherent risk for bacterial, viral, or opportunistic infections compared to the general population,” investigators stated. “Also, the use of immunosuppressive medications such as conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), biological disease-modifying anti-rheumatic drugs (bDMARDs), and corticosteroids in patients with autoimmune rheumatoid disease, increase the risk of these infections.”

Historically, extreme symptoms of COVID-19 were associated with age, obesity, long-term corticosteroid therapy, higher rheumatic disease activities, and comorbidities.

A telephone survey was conducted between July 1, 2020, and July 20, 2020, in which patients were interviewed using a standardized close-ended questionnaire. Investigators aimed for a total of 300 patients to be included, ultimately obtaining information from 278. The survey focused on whether participants continued their ongoing treatment plan after March 15, 2020, and how they made the decision to remain receiving treatment or discontinue usage. They were also asked if they had any hesitation in going to the hospital for either follow-up appointments or intravenous drug administration.

Participants were randomly selected from a tertiary referral center. Demographics, including age, gender, education level, diagnosis, disease duration, current treatment, comorbidities, and smoking status were recorded. Those with rheumatoid arthritis (RA) or ankylosing spondylitis (AS) who were receiving corticosteroids, csDMARDs, bDMARDs, targeted synthetic disease-modifying (tsDMARDs), and non-steroidal anti-inflammatory drugs were invited to participate.

The mean age of the patients was 47.53 years and 64.4% (n = 179) patients were female. The survey found that 22.3% (n = 62) patients reduced or interrupted treatment and only 3.9% (n = 11) patients stopped treatment entirely. The duration of disease (p = 0.023) and disease activity (p = 0.001) were significant contributing factors in the decision to discontinue treatment. Demographics did not impact treatment decision.

A total of 135 (48.6%) patients made their decision by themselves, with 80% of these patients choosing to continue their current treatment plan. A co-decision with the rheumatologist was reported in 111 (39.9%) patients, with 76.6% opting to maintain treatment.

In the group who discontinued therapy, anxiety (48.4%), inability to go to the hospital (45.1%), and inability to obtain the drug (6.5%) were reported. Only 3 patients (1.1%) had an infection requiring hospitalization in the last year, however, 89.6% of patients were concerned about hospital visits.

The study was limited by the small number of patients targeted to participate. While this may have been remedied by sending emails to the entire database, investigators sought to analyze the data without the influence of socio-cultural status and low education level.

“The adherence of rheumatology patients to treatment was investigated in this study in the early period after the announcement of the COVID-19 pandemic, and it was found that treatment adherence was high,” investigators concluded. “It was observed that treatment was considerably more stopped, particularly in patients with longer illness duration. Therefore, it may be intended to provide patients with better information not to disrupt therapy.”

Reference:

Coskun BN, Yagiz B, Pehlivan Y, Dalkilic E. Attitudes of patients with a rheumatic disease on drug use in the COVID-19 pandemic. Adv Rheumatol. 2021;61(1):55. Published 2021 Sep 3. doi:10.1186/s42358-021-00211-6