Treatment adherence of patients with rheumatoid arthritis during Covid-19 pandemic

ABSTRACT

Background: Covid-19 impacted not only people's lives but also slowed down the healthcare delivery system and supply chain leading to a global drug shortage.1 According to the Ministry of Statistics, India's growth in the year 2020 went down by 3.1% because of the pandemic, which impacted patient's capacity to continue with the expenditure related to chronic disease management. Rheumatoid arthritis (RA) for a patient comes with a out-of- pocket high cost long term immunosuppressive medicine and increased chances of secondary infections leads to non-adherence of patients. The current study is to observe the adherence to Janus Kinase (JAK) inhibitors in a hospital-based rheumatology service in Eastern India during the Covid-19 pandemic period. Method(s) Data of the patients enrolled physically and electronically under active follow-up in the Rheumatology Outpatient Department (OPD) of the hospital were analyzed.2 The patients with a confirmed diagnosis of RA, receiving JAK inhibitors for 6 months or more were included in the study from 21st March 2020 to 31st July 2020. A questionnaire was also administered to these patients to understand the impact of Covid-19 on the treatment of RA. Data related to demographic features, clinical, laboratory, drug history, and current treatment were collected and statistically analyzed. Result(s) Out of the total 42 patients (aged 38-76 years) who received JAK inhibitors, 24 (6 were COVID positive) were seen with the OPD during the Covid-19 pandemic. In our study, a higher proportion of patients with an annual income of INR 1M-1.5M had a 15% income decrement (Figure 1), though the patient adherence to JAK inhibitors was high compared to biologics, even in the patients who faced up to 25% reduction in annual income. Out of 24, only 4 patients stopped the treatment with JAK inhibitors due to the limited availability during the initial period of the lockdown. Overall patient adherence to JAK inhibitor treatment was 85% and was higher compared to the biologics (previous data). There was higher non-adherence in the biologic group at lower-income slabs (5-10 Lacs & 10-25 Lacs group) than in the higher income slabs, compared to JAK inhibitors inspite of better availability. Higher-income groups showed lower non-adherence in both groups. Conclusion(s) In the milieu of the Covid-19 pandemic, the treatment adherence in patients with RA was driven by the cost and availability of the medication amidst the pandemic. The association of injectable biologics with higher immunosuppression in patients perception during pandemic also affected the treatment adherence in patients. Thus it can be concluded that patient perception and availability were the main driving factor in adherence to RA therapy.