Medication Management Preferences Depend on Case Burden

A survey of rheumatologists in the United States found that their prescriptions of medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), biologics and steroids during the COVID-19 pandemic is based on regional case burden rather than American College of Rheumatology (ACR) guidance.

The study was led by rheumatologist Bella Mehta, M.B.B.S., of the Hospital for Special Surgery/Weill Cornell Medicine in New York. The results, which were published in Seminars in Arthritis and Rheumatism in June, were recently presented at the annual meeting of the American College of Rheumatology.

A total of 271 respondents completed the online survey that was administered from April 8 to May 4, 2020. Of the respondents, 48 percent disagreed that patients with rheumatic diseases are at increased of COVID-19 irrespective of their immunosuppressive medications.

“Most rheumatologists agreed that their autoimmune patents are at higher COVID-19 risk, regardless of being on immunosuppressive medications, and this was consistent across all U.S. regions,” said Dr. Mehta in an interview with Rheumatology Network.

The ACR guidance for the management of adults with rheumatic disease during the COVID-19 pandemic recommends that patients on standing immunosuppressive medications should be maintained on their long-term therapy and these drugs should only be withheld during COVID-19 infection.

The survey found that while 50 percent of rheumatologists agreed and acted on this guidance for biologics, a higher proportion of rheumatologists in the Northeast region of the country did not agree as compared with the rest of U.S. Similarly, 56 percent of rheumatologists acknowledged the pandemic has led them to reduce the use/dosage/frequency of steroids, which is in accordance with the early ACR guidance that recommended altering steroids to the lowest dose possible to control rheumatic disease.

A third of respondents indicated that at least 10 percent of their patients had self-discontinued or reduced at least one immunosuppressive drug to lessen their risk of COVID-19. Meanwhile, 13 percent of respondents indicated more than a quarter of their patients had self-discontinued or reduced at least one immunosuppressive drug. More rheumatologists in the Northeastern and Southern states reported a higher frequency of this finding (NE:15 percent, MW:6 percent, S:16 percent,W:10 percent).

“There were significant differences in the management of biologics, steroids and NSAIDs in response to COVID-19, reported by rheumatologists in areas with a high case burden (NE), compared to those in less affected areas (MW),” Dr. Mehta said. “We saw a reduction in reported medication prescriptions in regions where the burden was higher.”

“The results of our study have showed that rheumatologists have based their changes in practice on the regional case burden, despite the release of broad guidelines from ACR,” Dr. Mehta said.

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REFERENCE

ABSTRACT: 0005.“Geographical Variations in COVID-19 Perceptions and Patient Management: A National Survey of Rheumatologists.”The annual meeting of the American College of Rheumatology. 11:00 AM, Friday, Nov. 6, 2020.

Bella Mehta, Deanna Jannat-Khahab, Carol A. Mancuso, et al. “Geographical variations in COVID-19 perceptions and patient management: a national survey of rheumatologists.” Seminars in Arthritis and Rheumatism. July 6, 2020. https://doi.org/10.1016/j.semarthrit.2020.06.017