AB0684 LESS THAN 20% OF PATIENTS WITH A CHRONIC INFLAMMATORY RHEUMATIC DISEASE CHANGED THEIR IMMUNOSUPPRESSIVE MEDICATION BECAUSE OF THE COVID 19 PANDEMIC
Authors: I. Andreica, R. Jast, G. Rezniczek, U. Kiltz, D. Kiefer, B. Buehring, X. Baraliakos, J. Braun
Journal: Annals of the Rheumatic Diseases (2021)

Background: The best treatment options of patients with chronic inflammatory rheumatic diseases (CIRD) in the pandemic have not been completely clear, especially in the beginning of the lockdown. Whether and to which degree pandemic-related therapy changes have occurred, has not been studied in detail. Objectives: To study the behaviour of patients with CIRD initially facing the COVID 19 pandemic related to their disease status and medication. Methods: Patients with CIRD were contacted by telephone to assess their health status and ask for changes in medication. Standardized assessment tools were used to assess disease activity, depression and anxiety. High disease activity was assumed if RADAI-5 ≥ 3.2 and BASDAI ≥ 4. Anxiety (HADS-A) and depression (HADS-D) of patients were assessed using HADS. A score &lt; 8 was taken as indication of no major problem in this regard. Results: A total of 886 patients was interviewed between April 15 and June 15 of 2020. Here we report on 550 patients with complete information on standard assessments (62%). About 60% were female, mean age 54.4±13.7, mean disease duration 12.2±10.5 years. Most had spondyloarthritis (SpA, n=287) including axial SpA (axSpA, n=172) and psoriatic arthritis (PsA, n=116), in total 52.2%, while 40.2% had rheumatoid arthritis (RA, n=221), and 7.6% connective tissue diseases (CTD, n=42). Most RA patients were on methotrexate (48.8%), while 43.8% took glucocorticoids. In addition, 61.0% of patients were on bDMARDs, mostly on TNF inhibitors (59.6%). More SpA than RA patients were on bDMARDs: 71.0% vs 49.7% respectively. A recent change in medication was reported by 182 patients (33.1%): 89 with RA (40.2%), 88 with SpA (30.6%) and 5 with CTD (11.9%). Half of those who changed (n=92; 50.5%) admitted that the change was mainly made due to fear of the pandemic (16.7% of all patients). Altogether, significantly more patients changed bDMARDs (68.5%) than csDMARDs (57.3%). The data of patients who changed vs patients who didn’t change is shown in the Table 1, including subgroup analyses. The median HADS scores were &lt; 8. Table 1. RA and SpA patients who changed and who did not change their medication Group (N) / Reason N Active disease (% ) HADS-D ≥ 8 (% ) HADS-A ≥ 8 (% ) bDMARD therapy (% ) Rheumatoid arthritis 221 134 (60.6) 76 (35.0) [4] 94 (43.3) [4] 110 (50.9) [5] Spondyloarthritis 287 130 (45.4) 83 (29.5) [6] 109 (38.8) [6] 204 (72.6) [6] P a (RA vs SpA) &lt;0.001 0.228 0.354 &lt;0.001 Patients did not change their medication Rheumatoid arthritis (%) 132 (59.7) 84 (63.6) 46 (35.9) [4] 58 (45.3) [4] 62 (48.4) [4] Spondyloarthritis (%) 199 (69.3) 88 (44.2) 58 (30.1) [6] 69 (35.8) [6] 137 (71.0) [6] P (RA vs SpA) 0.031 &lt;0.001 0.358 0.101 &lt;0.001 Patients changed their medication Rheumatoid arthritis 89 (40.3) 50 (56.2) 30 (33.7) 36 (40.4) 48 (54.5) [1] P (vs no change) 0.331 0.846 0.567 0.457 Reason [9] Pandemic 41 (51.3) 15 (36.6) 11 (26.8) 14 (34.1) 24 (60.0) [1] Inactive disease 23 (28.8) 12 (52.2) 6 (26.1) 10 (43.5) 12 (52.2) Active disease b 16 (20.0) 14 (87.5) 6 (37.5) 7 (43.8) 7 (43.8) P (reasons) 0.003 0.687 0.687 0.526 Spondyloarthritis 88 (30.7) 42 (47.7) 25 (28.4) 40 (45.5) 67 (76.1) P (vs no change) 0.673 0.889 0.157 0.451 Reason [6] Pandemic 50 (61.0) 22 (44.0) 13 (26.0) 22 (44.0) 42 (84.0) Inactive disease 15 (18.3) 7 (46.7) 4 (26.7) 7 (46.7) 10 (66.7) Active disease b 17 (20.7) 11 (64.7) 6 (35.3) 6 (35.3) 11 (64.7) P (reasons) 0.331 0.756 0.774 0.156 P (RA vs SpA) 0.031 0.294 0.950 0.603 0.004 Data are presented as numbers (percentage proportions; across rows except for column N) or medians (interquartile ranges). Missing values are in square brackets. a P values calculated using χ 2 test or Mann-Whitney rank sum test. b Self-reported claim of disease activity. Conclusion: Two thirds of patients did not change medication but one third changed. A relatively high number of patients did so due to fear of the pandemic, mostly those on biologics. There were no major differences between RA and SpA. Anxiety and depression do not seem to play an important role for the decision to change medication (Table 1 below). Disclosure of Interests: None declared