The influence of the SARS-CoV-2 lockdown on patients with inflammatory rheumatic diseases on their adherence to immunomodulatory medication: a cross sectional study over 3 months in Germany

Abstract

Objectives To evaluate the influence of the SARS-CoV-2 pandemic on the adherence of patients with inflammatory rheumatic diseases (IRD) to their immunomodulatory medication during the three-months lockdown in Germany. Methods From March 16th until June 15th 2020, IRD patients from private practices and rheumatology departments were asked to answer a questionnaire addressing their behaviour with respect to their immunomodulating therapy. Eight private practices and nine rheumatology departments which included rheumatology primary care centres and university hospitals participated. 4252 questionnaires were collected and evaluated. Results The majority of patients (54%) were diagnosed with rheumatoid arthritis, followed by psoriatic arthritis (14%), ankylosing spondylitis (10%), connective tissue diseases (12%) and vasculitides (6%). The majority of patients (84%) reported to continue their immunomodulatory therapy. Termination of therapy was reported by only 3% of the patients. The results were independent from the type of IRD, the respective immunomodulatory therapy and by whom the patients were treated (private practices vs rheumatology departments). Younger patients (<60 years) reported just as often as older patients to discontinue their therapy. Conclusion The data show that most of the patients continued their therapy in spite of the pandemic. A significant change in behavior with regard to their immunomodulatory therapy was not observed during the three months of observation. The results support the idea that the immediate release of recommendation of the German Society of Rheumatology were well received, supporting the well-established physician-patient-relationship in times of a crisis.

TNFi is associated with positive outcome, but JAKi and rituximab are associated with negative outcome of SARS-CoV-2 infection in patients with RMD

“…Although most patients continue their RMD treatment in the pandemic as stated in the treatment recommendations, in the case of an acute symptomatic infection especially in hospitalised patients, it is recommended to pause the immunomodulating treatment. 26–28 Differential effects of the RMD treatment might therefore also be explained by different half-lives of these drugs.…”

Evaluation of a Non-Face-to-Face Multidisciplinary Health Care Model in a Population with Rheumatoid Arthritis Vulnerable to COVID-19 in a Health Emergency Situation

“…Adult patients with rheumatological conditions were surveyed in the United States (mainly RA) [ 18 ] to assess concerns and healthcare-related behavior, and 14.9% of them showed a decrease in the use of DMARD. In contrast, researchers that evaluated inflammatory rheumatic disease (majority RA) patients in Germany [ 10 ] for three months of follow-up had only 4% of the patients report discontinuing their medication on their own, or in consultation with their rheumatologists. Furthermore, North American patients surveyed between April and May 2020 [ 41 ] had a higher likelihood of stopping medication with a telemedicine visit when compared to patients with an office visit.…”

“…Assessing the level of adherence under telemedicine during the pandemic will help determine subsequent measures to follow and ensure good clinical outcomes. Some preliminary studies suggest that most patients continued their therapy in spite of the pandemic [ 10 ].…”

COVID-19 und rheumatische Erkrankungen – bisherige Erkenntnisse der Pandemie

“…In einer longitudinalen Befragung von ca. 4000 Patienten im Zeitraum von März bis Juni 2020 gaben erfreulicherweise lediglich 3 % der befragten Personen bundesweit an, ihre Therapie zu beenden [16]. Dies war sehr beruhigend, da ein selbstständiges Absetzen der Therapie mit einer Zunahme der Krankheitsaktivität und der Notwendigkeit einer Therapie-Intensivierung einhergehen kann.…”