Rheumatoid arthritis

Patients anxious about DMARDs and COVID-19 risk

Patients with rheumatic diseases are concerned about their medications increasing the risk of COVID-19 disease, particularly those on combination csDMARDs or a b/tsDMARD, Australian research shows.

A survey of 550 patients at the Monash Health Department of Rheumatology Department found that 56% were concerned that their medications would increase their risk of contracting COVID-19, and 76% were concerned that medications would increase their risk of severity

The medication concerns were greatest for patients on cyclophosphamide (100%), followed by mycophenolate (70%), b/tsDMARDs, (62%) and  patients on azathioprine (57%) and methotrexate (55%) .

In multivariate analysis, the use of combination csDMARDs (odds ratio 12.06) or combinations of b/tsDMARD + csDMARD(s) + prednisolone (odds ratio 22.3) had the strongest associations with believing that medication(s) increases the severity of COVID-19.

Only a minority of patients on prednisolone (38%) were concerned regarding the risk it posed, despite its consistent associations with infection risk in observational studies. This may reflect the fact that most patients were on low doses of ≤5mg/day, the study authors said.

Patients were least concerned about NSAIDs (28%) affecting COVID-19 risk, although some patient taking hydroxychloroquine were still concerned about it increasing their risk of COVID-19 despite widespread publicity about it being a potential prophylaxis treatment.

The survey was conducted in response to text messages in which patients were directed to the ARA COVID-19 Information sheet and to answer several questions. The response rate was 21%, with the most common self-reported diagnoses being rheumatoid arthritis (29.7%) and systemic lupus erythematosus (19.2%).

Two thirds of the patients (64% ) were on one or more conventional synthetic disease-modifying antirheumatic drug (csDMARD) and 18% were on a biologic or targeted synthetic anti-rheumatic drug (b/tsDMARD).

Most of the patients said they had already obtained information about COVID-19 and their illness, and 63% said the ARA information sheet had not changed their existing plan to continue their medications. However 30% of patients reported that they were more likely to stay on their medications as a result of receiving the information.

The survey also found there was overwhelming acceptance (98.4%) of tele-rheumatology consultation in lieu of face-to-face appointments during the COVID-19 pandemic. Patients were most likely to accept telehealth if their condition was well-controlled, if their rheumatologist felt it was appropriate, and if the consultation was with a rheumatologist who knew their case well. A minority (28%) of patients said they believed telehealth was only appropriate in times of strict infection control.

The study authors said the survey showed that many Australian patients with rheumatic conditions had significant and often unfounded concerns regarding their risk of contracting or having more severe COVID-19 disease.

“The key finding is that the need for information in patients with rheumatic diseases is high, particularly in regards to the risk posed by their diseases and medications,” they wrote in Arthritis Care.

“The dissemination of patient information has the potential to avoid unnecessary patient-directed changes to therapy, which may minimise the risk of disease,” they concluded.

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