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Medication Management Preferences Depend on Case Burden

Rheumatology Network reports on a survey of U.S. rheumatologists by HSS rheumatologist Bella Mehta, MBBS, MS presented at the virtual American College of Rheumatology (ACR) annual meeting, indicating that their prescriptions of medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), biologics and steroids during the pandemic is based on regional case burden rather than ACR guidance.

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.

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 (NE) 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 NE 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),” said Dr. Mehta. “We saw a reduction in reported medication prescriptions in regions where the burden was higher,” she noted.

Read the full article at Rheumatologynetwork.com.