Medication Interruptions and Subsequent Disease Flares During the COVID‐19 Pandemic: A Longitudinal Online Study of Patients With Rheumatic Disease

Abstract

Objective. We aimed to assess trends in anxiety and interruptions in disease-modifying antirheumatic drug (DMARD) use among patients with rheumatic diseases during the COVID-19 pandemic and to evaluate whether DMARD interruptions were associated with disease flares.Methods. ArthritisPower, the Vasculitis Patient-Powered Research Network, and other patient organizations invited members to join a 52-week longitudinal study, with baseline surveys completed March 29 to June 30, 2020, with follow-up through May 2021. Logistic regression incorporating generalized estimating equations evaluated associations between interruptions in DMARD use and self-reported disease flares at the next survey, adjusting for demographic characteristics, medications, disease, and calendar time.Results. Among 2,424 patients completing a median of 5 follow-up surveys, the mean age was 57 years, 87% were female, and the most common conditions were rheumatoid arthritis, vasculitis, and psoriatic arthritis. Average Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety T scores decreased from April 2020 (58.7) to May 2021 (53.7) (P < 0.001 for trend). Interruptions in DMARD use decreased from April (11.2%) to December 2020 (7.5%) (P < 0.001) but increased through May 2021 (14.0%) (P < 0.001). Interruptions in DMARD use were associated with a significant increase in severe flares (rated ≥6 of 10) at the next survey (12.9% versus 8.0% [odds ratio (OR) 1.71 (95% confidence interval [95% CI 1.23, 2.36]) although not any flare (OR 1.18 [95% CI 0.89, 1.58])].Conclusion. Anxiety and interruptions in DMARD use initially decreased over time, but DMARD interruptions increased during 2021, possibly related to an increase in COVID-19 cases or vaccine availability. Interruptions in DMARD use were associated with increased rates of severe disease flares, highlighting the importance of avoiding unnecessary DMARD interruptions.

Rheumatic disease patient decision-making about COVID-19 vaccination: a qualitative analysis

“…A survey of vaccinated RMD patients found 18% of participants did not communicate with their provider about vaccination, and 71% did not withhold DMARDs peri-vaccination [36]. The prevalence of pandemic-period DMARD nonadherence is between 7.5 and 14.8% [37,38]. To maximize vaccine effectiveness, it is important for rheumatologists to communicate with patients about coordination of DMARDs peri-vaccination.…”

DMARD disruption, disease flare, and prolonged symptom duration after acute COVID-19 among participants with rheumatic disease: A prospective study

“…Medication disruption may have contributed to flare and increased disease activity that persisted through to the time of survey completion. Prior studies have focused mainly on DMARD changes early in the pandemic related to concerns about drug supply or immunosuppression (32)(33)(34). Other studies have focused on temporary medication changes after COVID-19 vaccination and have found little evidence of increased risk of flare (35)(36)(37)(38).…”

Novel insights into the management of rheumatoid arthritis: one year in review 2022

“…These data support the notion that temporary discontinuation of MTX can enhance immune response in patients receiving SARS-CoV-2 vaccines. However, clinicians should be aware of the risk of disease flare following even transient interruption of concomitant immunosuppressive treatments, which is possible in particular in case of COVID-19 cases or vaccines administration (40). Second, the entity of seroconversion is different in RA Vs controls, even if a temporary withdrawal of the drug is undertaken.…”