Article Text
Abstract
Background Rheumatoid Arthritis (RA) is a complex autoimmune disease which affects the joints and various organs1 and patients may experience frequent and painful flare ups. Besides conventional therapies, multiple bDMARDS are approved to treat RA, including tocilizumab and sarilumab. With IL-6 inhibitors being approved for emergency use to treat critically ill COVID-19 patients, this may influence the treatment paradigms of some RA patient cohorts.
Objectives The objective of this study is to observe the landscape of RA patients treated with IL-6 inhibitors during the COVID-19 pandemic period, compared to the pre COVID-19 period.
Methods A multi-centre online medical chart review study of patients with RA was conducted between January 2019 – March 2020 (“pre-COVID”) and April 2020 – June 2021 (“during-COVID”) among UK, FR, DE, IT & ES rheumatologists practicing across hospital and private practices. Recruited from a large access panel, physicians were screened for duration of practice in their specialty (3-30 years) and caseload (2 or more RA patients seen in an average week). Participants were asked to complete a 3-part survey online: (1) a doctor demographic questionnaire, (2) a perceptual questionnaire, and (3) patient charts for the next 5 biologic/JAKi receiving RA patients seen following receipt of the survey, which captures patient demographics and treatment history. Descriptive statistics were used to analyse the data.
Results For the pre-COVID cohort, 1283 physicians were recruited and collectively reported 6250 RA patients, 754 of which were treated with IL-6 inhibitors for their RA. For the during-COVID cohort, 1279 physicians were recruited and collectively reported 6188 RA patients, 760 of which were treated with IL-6 inhibitors for their RA.
96% of sampled physicians cited access to IL-6 inhibitors in hospital or practice in the during-COVID period, compared to 77% in the pre-COVID period (p<0.01) - this may be linked to the approval of emergency use of IL-6 inhibitors to treat critically ill COVID-19 patients, hence making it more widely available during this period.
A larger proportion of reported IL-6 inhibitor patients in the during-COVID cohort had stayed on this drug class for more than 6 months, compared to the pre-COVID cohort (67% vs 62%, p<0.05).
Association with high-risk comorbidities, severity of RA at diagnosis and previous therapies received were key areas of differentiation between the two reported patient groups. For the during COVID cohort, IL-6 patients were significantly more likely to be recorded as having concomitant metabolic conditions vs the pre-COVID cohort (72% vs 48%, respectively; p<0.01) and respiratory conditions (4% vs 1%, respectively; p<0.01). Furthermore, reported IL-6 patients from the during COVID cohort were significantly more likely to have their RA classified as ‘severe’ (physician-defined) at the time of diagnosis vs pre-COVID reported IL-6 patients (41% vs 33%, respectively; p<0.01) and were significantly more likely to have switched from previous TNFi/CD20 biosimilar therapy compared to the pre-COVID cohort (16% vs 7%, respectively; p<0.01).
Conclusion From the sample surveyed, it appears that high risk comorbidities, severity of RA at diagnosis and type of previous therapy are key differentiating points behind IL-6 usage in RA patients pre vs during the COVID-19 pandemic. With the increasing risk that RA patients may experience severe side effects if infected with COVID-192 and guidance to use IL-6 inhibitors in certain patient cohorts during this time, this may explain the patterns seen in our dataset. Further investigation using comparator cohort is warranted.
References [1]Yip, Ronald Man Lung FRCP (Edin), FHKCP*; Yim, Cheuk Wan FRCP, FHKCP† Role of Interleukin 6 Inhibitors in the Management of Rheumatoid Arthritis, JCR: Journal of Clinical Rheumatology: December 24, 2019 - Volume - Issue - doi: 10.1097/RHU.0000000000001293
Disclosure of Interests None declared