POS1485-HPR PATIENTS’ PERSPECTIVE ON CONTINUATION VERSUS TEMPORARY INTERRUPTION OF IMMUNOMODULATORY AGENTS DURING INFECTIONS IN PATIENTS WITH IMMUNE-MEDIATED INFLAMMATORY DISEASES: AN INTERVIEW STUDY
Authors: M. Opdam, L. M. Verhoef, J. Vriezekolk, B. Van den Bemt, A. Den Broeder
Journal: Annals of the Rheumatic Diseases (2021)

Background: Immune mediated inflammatory diseases (IMIDs) like rheumatoid arthritis (RA) are often treated with immunomodulatory agents (IA). Infection risks appear to be slightly increased in IMID patients using IA 1 . However, it remains uncertain whether it is best to continue or temporary interrupt IA in case of an infection For this decision, it is essential to know patient’s perceptions about both strategies. Unfortunately, little is known about the patients’ perceptions on this topic. Objectives: To explore the patients’ perspectives on continuation and temporary interruption of IA in case of an infection and assess possible barriers and facilitators. Methods: Semi-structured interviews were conducted in IMID patients using IA. Patients were recruited from the rheumatology, dermatology and gastroenterology departments of two hospitals in the Netherlands. Purposive sampling was used to select a diverse patient population. Semi-structured interviews were performed until data saturation was reached and analyzed using inductive thematic analysis. Results: 19 patients with 6 different IMIDs and 17 different IA were interviewed. The majority was female, mean age 51 years and mean disease duration 17 years. Four had experienced a severe infection (requiring hospitalization). 15 patients indicated that they would prefer to continue their IA in case of an infection, however, for most patients this would depend on the infection severity. Several facilitators and barriers were identified (Table 1). Patients mentioned disease flare as a barrier for temporary interruption. Beliefs about susceptibility to infections form barriers and facilitators for both temporary interruption and continuation. Patients also mentioned that they would follow their physician’s advice on continuation/temporary interruption. Table 1. Identified barriers and facilitators Temporary interruption Barriers Disease flare and its impact Loss of IA effects or increased side effects after restarting Long duration of interruption Belief: IA has no/a positive effect on infection (risk) Belief: not more susceptible for infections Practical barriers Not aware of possibility of interruption Not following physician’s advice Facilitators More severe and/or longer lasting infection Interactions with medication needed for infection Positive effect of interruption on immune system Short duration of interruption Belief: more susceptible for infections Belief: IA has a negative effect on infection (risk) Concerned about infections Current stable disease Physician’s advice Long duration of IA effects Wish to taper/stop IA in general Negative impact of infection on daily activities Continuation Barriers Belief: more susceptible for infections Belief: IA has a negative effect on infection (risk) Negative previous experiences during infection Loss of IA effects after long use Interactions with medication needed for infection Facilitators Belief: not more susceptible for infections Belief: IA has no/a positive effect on infection (risk) Not concerned about infections IA needed to control IMID Mild infection Positive previous experiences with continuation Physician’s advice Conclusion: Interviewed patients seemed to prefer continuation of IA during an infection if possible. The concern of disease flare might form a barrier for temporary interruption, this is in line with a previous study, showing that RA patients fear disease flare after dose reduction 2 . References: [1]Singh JA, Cameron C, Noorbaloochi S, Cullis T, Tucker M, Christensen R, et al. Risk of serious infection in biological treatment of patients with rheumatoid arthritis: a systematic review and meta-analysis. Lancet. 2015;386(9990):258-65. [2]Verhoef LM, Selten EMH, Vriezekolk JE, de Jong AJL, van den Hoogen FHJ, den Broeder AA, et al. The patient perspective on biologic DMARD dose reduction in rheumatoid arthritis: a mixed methods study. Rheumatology. 2018;57(11):1947-55. Disclosure of Interests: Merel Opdam Grant/research support from: has received research grants (to the institution) from Gilead, L.M. Verhoef: None declared, Johanna Vriezekolk: None declared, Bart van den Bemt: None declared, Alfons den Broeder Grant/research support from: has received consultancy honoraria, congress invitations and research grants (to the institution) from Abbvie, Amgen, Cellgene, Roche, Biogen, Lilly, Novartis, Celltrion Sanofi, Gilead. Is coinventor on a rituximab related patent (pending)