Researchers conducted a study to assess the medical and clinical changes patients with rheumatoid arthritis (RA) experienced during the first 3 months of the COVID-19 pandemic in the US.
Patients with RA participating in the FORWARD observational registry answered web-based surveys to provide the research team with an understanding of medication use. Baseline characteristics and medication use was also available for 2019. The team compared disease-modifying antirheumatic drug (DMARD) exposure pre-COVID using logistic models, and they adjusted for age, sex, comorbidities including pulmonary and cardiovascular diseases, education, health insurance, RA activity (PAS-II), fatigue, and polysymptomatic distress (PSD). Finally, the team assessed the rate of medication change before and after the first COVID-19 ACR treatment guidelines in April.
Data was gathered from more than 700 respondents, 30% reported medication changes. Patients that changed their medication were more likely to use glucocorticoids (GCs, 33% vs 18%), and less likely to use non-hydroxychloroquine and conventional synthetic DMARDs (49% vs 62%) pre-COVID. Comparatively, JAKi use was associated (odds ratio [OR] 1.9) with change in bivariate analyses, GCs were the only strong factor (OR 3.0 [1.9, 4.9]) in multivariable models. The team found changes in care were more likely associated with pulmonary disease (OR 2.9 [1.3, 6.5]) and GC use (OR 1.6 [1.0, 2.5]). While change in medication before and after April 15 stayed the consistent there was a change in initiation, patient-initiated changes due to COVID-19 were twice as likely before April 15, and physician-guided changes were more likely after.
The study team found that during the first 3 month of the COVID-19 pandemic, patients with RA made considerable changes to their medication use. Data indicated almost half of patients that decreased or discontinued use of DMARDs did so without guidance from their physician. While medication changes after ACR recommendations were done with an increase in physician guidance.