Pandemic DMARD Interruptions Linked With Severe Disease Flares

The COVID-19 pandemic caused substantial anxiety and frequent interruptions in disease-modifying antirheumatic drug (DMARD) use among patients with autoimmune rheumatic disease in the United States, according to a study published in Arthritis Care & Research.

“Importantly, interruptions in DMARD use were associated with self-reported severe disease flares, demonstrating the impact of these DMARD interruptions on patient health,” wrote corresponding author Michael D. George, MD, of the University of Pennsylvania, and coauthors.

The study included 2424 adult patients from ArthritisPower and vasculitis patient-powered research networks, the CreakyJoints patient community, and partnering patient organizations. Participants filled out baseline surveys between March 29, 2020, and June 30, 2020, followed by a median five follow-up surveys through May 2021. The most common conditions represented were rheumatoid arthritis, vasculitis, and psoriatic arthritis.

Average Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety T scores decreased significantly from 58.7 in April 2020 to 53.7 in May 2021, according to the study. Interruptions in DMARD use decreased from 11.2% in April 2020 to 7.5% in December 2020 (7.5%). Between January 2021 and May 2021, however, DMARD interruptions rose to a high of 14.0%.

“This increase could be related to a surge of COVID-19 cases during this time period, but because anxiety continued to decrease, it seems possible that interruptions in DMARD use were related to patient or physician concerns about the effect of medications on vaccine efficacy, which were not fully captured in this study,” researchers wrote.

Interruptions in DMARD use were linked with a significant increase in severe flares, but not flares of any severity, at the next survey. Researchers reported a 1.71 odds ratio for severe flares at the next survey with DMARD interruption compared with no interruption.

“Avoiding unnecessary and prolonged interruptions in DMARD use may help avoid disease flares,” the authors advised. “Ensuring that patients have continuity of care and continued communication with their physicians is critical to helping patients navigate a confusing and constantly changing landscape.”

—Jolynn Tumolo

Reference:
Dharia T, Venkatachalam S, Baker JF, et al. Medication interruptions and subsequent disease flares during the COVID-19 pandemic: a longitudinal online study of patients with rheumatic disease. Arthritis Care Res. 2022;74(5):733-740.