AB0704 TELEMEDICINE AT THE TIME OF COVID-19: THE EXPERIENCE WITH RA PATIENTS TREATED WITH JAK-INHIBITORS
Authors: C. Garufi, F. R. Spinelli, S. Mancuso, F. Ceccarelli, F. Conti
Journal: Annals of the Rheumatic Diseases (2021)

Background: The spread of COVID-19, the lockdown, the limited access to care reevaluated the role of tele-consultation and self-assessment. Objectives: Our aim was to evaluate in a cohort of Rheumatoid Arthritis (RA) patients treated with JAK-inhibitors (JAKi): the self-assessed disease activity during lockdown, the lockdown impact on fatigue, anxiety, depression and the prevalence of Covid-19. Methods: We enrolled RA patients treated with baricitinib or tofacitinib. At baseline (BL) and follow-up we collected: patients’ demographic data, composite disease activity indices (CDAI, DAS28 CRP ), global assessment (PGA), pain visual analogue scale (VAS), FACIT (functional assessment of chronic illness therapy) and a self-rating scale for disease impact on anxiety and depression (Zung-A/D). Patients were instructed on how to perform self-assessment through video-material and fulfilled the online form of “Rheumatoid Arthritis Impact of Disease” (RAID) 1 and “RA Disease Activity Index” (RADAI). To capture the pandemic effect, we compared patients in different status (remission, low, moderate and high-disease activity) at the last in-person visit (preCoV) through the DAS28 CRP and CDAI, to the tele-health visit (THV), measured by the RAID. BL and pre-CoV ZUNG-A, ZUNG-D, FACIT questionnaires were compared with the online results during the pandemic. Exposure, tests and symptoms of Covid-19 were recorded. Data were expressed as mean±standard deviation or median(IQR) according to distribution. Results: Twenty patients (median age 58.2±11.9 and mean disease duration 153.5 ± 112.7 months) were treated with tofacitinib and 27 with baricitinib. The median time-lapse between the pre-CoV visit and the THV was 12 (IQR 4) weeks. DAS28CRP and CDAI significantly decreased from BL to pre-CoV visit. During the last in-person visit, 21 patients (48.83%) were in remission, 9 (20.93%) in low disease activity; according to the RAID, 15 (31.91%) and 7 (14.89%) patients were respectively in remission and low disease activity during the THV (Table A). PGA and pain significantly decreased from BL to pre-Cov visit but worsened during the lockdown (Table A). FACIT remaining stable during THV. At THV, we detected a significant improvement of anxiety from BL (Zung-A) and a tendency to lower depression scores compared to BL (Table A). JAKi showed a good safety profile considering Covid-19 symptoms, none of the patients was diagnosed with SarsCoV2 infection. Conclusion: This is the first study on virtual assessment in RA patients treated with JAKi. The unique social experiment of the pandemic impaired the clinical response already achieved before the lockdown, without a collateral worseling of FACIT, anxiety and depression. References: [1]Gossec L, et al. Ann Rheum Dis . 2009 [2]Stucki G, et al. Arthritis Rheum . 1995 Table A. DAS28, CDAI, RAID scores and patient-reported outcomes assessment at baseline and during the follow-up BL pre-CoV THV DISEASE ACTIVITY N (% ) N (% ) N (% ) REMISSION DAS28 0 (0%) 21 (48.8%) CDAI 0 (0%) 10 (22.7%) RAID 15 (31.9%) LOW DISEASE DAS28 1(2.1%) 9 (20.9%) CDAI 7(14.8%) 23 (52.2%) RAID 7 (14.9%) MODERATE DAS28 33 (70.2%) 12 (27.9%) CDAI 17 (37.1%) 8 (18.1%) RAID 13 (27.6%) HIGH DAS28 13 (27.6%) 1 (2.3%) CDAI 23 (48.9%) 3 (6.8%) RAID 12 (25.5%) GH 70 (30) 20 (49.5)* 45 (45)*# Pain 70 (28) 25 (45.5)* 40 (48.5)*# Zung A 37 (9) 37 (10.2) 35 (14)* Zung-D 39 (17) 39 (13)* 38 (12) FACIT 11.5 (17.2) 8 (19.5) 7(15) * p≤0.001 vs BL # p ≤0.04vs preCoV Data expressed as median (IQR) Disclosure of Interests: Cristina Garufi: None declared, Francesca Romana Spinelli Speakers bureau: Abbvie, Eli Lilly, Consultant of: Gilead/Galapagos, Eli Lilly, Grant/research support from: Pfizer, Silvia Mancuso: None declared, Fulvia Ceccarelli: None declared, Fabrizio Conti Speakers bureau: Abbvie, Eli Lilly, Sanofi, Pfizer, Consultant of: Gilead/Galapagos