Treatment Discontınuation Rates In Rheumatological Diseases During COVID-19 Pandemic

Öz

ABSTRACT Objective: In the COVID-19 pandemic, where the psychological dimension is intense, it can be thought that it may negatively affect the treatment cmpliance in rheumatological diseases in which immunosuppressives are used extensively. In our study, we wanted to examine the medication discontinuation rates and its related conditions in rheumatologic patients. Methods: Of those who continued their regular follow-up in the XXX City Training and Research Hospital Rheumatology outpatient clinics in the last year before the COVID-19 pandemic, 101 patients who had a routine outpatient clinic check-up between 1 April and 30 June 2020 and visited the polyclinic during this period were included in the study. In addition to these patients, 150 patients were randomly selected from a list created among those who came to the polyclinic regularly in the last year. These 150 selected patients were reached via mobile phones and their consent was requested. 104 of 150 patients gave consent to the study. The study was completed with a total of 205 patients. The patients were asked whether they stopped their medications, the reasons for the discontinuation, which drug(s) they stopped, and whether their disease and/or drugs increased their risk of COVID-19. Results: In 25/71 patients (35.2%) using steroids, stopped steroids. 26/79 patients (32.9%) using methotrexate; 10/28 (35.7%) patients using sulfasalazine; 18/38 (47.3%) patients using leflunomide; 19/45 (42.2%) patients using hydroxychloracine stopped their medication. The rate of patients who discontinued medication in patients using biological agents was 20/41 (48.8%). Among 71 patients who discontinued their medication, 30 (42.3%) of them stopped using their medication because of what they heard through television, newspapers and social media, 24 (33.7%) of them with the recommendation of a doctor or pharmacist, 10 (14.1%) of them due to drug supply problem, 7 (9.9%) of them stopped by their own decision without giving any reason. It was observed that 11 (55%) of the 20 patients who stopped using biological drugs, did so with the recommendation of a doctor or pharmacist. Conclusion: The most important finding of our study; It was observed that the highest rate of drug withdrawal in patients with rheumatic disease was those who used biological agents. Key Words: Adherens, COVID-19, Compliance, Immunosuppressive drug, Rheumatological Disease

Anahtar Kelimeler

• Adherens
• Compliance
• COVID-19
• Rheumatological Disease

ROMATOLOJİK HASTALIKLARDA COVID-19 PANDEMİ SÜRECİNDE TEDAVİYİ BIRAKMA ORANLARI

Öz

ÖZ Giriş/Amaç: Salgının psikolojik boyutunun yoğun görüldüğü COVID-19 pandemisinde immünsüpresiflerin yoğun kullanıldığı romatolojik hastalıklarda tedavide kalımı olumsuz etkileyebileceği düşünülebilir. Çalışmamızda romatoloji hastalarının ilaçları bırakma oranları ve ilişkili verileri incelemek istedik. Gereç ve Yöntemler: XXXXX Şehir Eğitim Araştırma Hastanesi Romatoloji polikliniklerinde COVID-19 salgını öncesindeki son bir yıl içerisinde düzenli takiplerine devam edenlerden rutin poliklinik kontrol zamanı 1 Nisan–30 Haziran 2020 arasında olan ve bu dönem içerisinde poliklinik ziyaretine gelen 101 hasta çalışmaya alındı. Bu hastalara ek olarak son bir yıl içerisinde poliklinik kontrollerine düzenli gelenler arasında oluşturulan bir liste içerisinden 150 hasta da rastgele seçim yöntemiyle seçildi. Seçilen bu 150 hastaya da cep telefonları vasıtasıyla ulaşılarak onam istendi. 150 hastanın 104’ü çalışmayı kabul etti. Toplam 205 kişi ile çalışma tamamlandı. Hastalara pandemi öncesi kullandıkları ilaçlarını kesip kesmedikleri, kesenlerin kesme gerekçeleri, hangi ilacı/ilaçları kestikleri, hastalıklarının ve/veya kullandıkları ilaçların COVID-19’a yakalanma risklerini arttırıp arttırmadığı soruldu. Bulgular: Steroid kullanan 25/71 hasta (%35,2) ilacını kesmiş idi. Metotreksat kullanan 26/79 (%32,9) hasta, sulfasalazin kullanan 10/28 (%35,7) hasta, leflunomid kullanan 18/38 (%47,3), hidroksiklorakin kullanan 19/45 (%42,2) hasta ilacını kullanmayı bırakmıştı. Biyolojik ajan kullanan hastalardaki ilaç kesen hasta oranı ise 20/41 (%48,8) saptanmış olup en yüksek ilaç terk etme oranı olarak gözlendi. İlacını kesen 71 hastanın 30’u (%42,3) televizyon, gazete ve sosyal medya aracılığıyla duydukları sebebiyle, 24’ü (%33,7) bir doktor veya eczacı tavsiyesiyle, 10’u (%14,1) ilaç temin sorunu sebebiyle, 7’si (%9,9) ise herhangi bir sebep bildirmeden kendi kararıyla kesmiştir. Kullandığı biyolojik ilaçları kesen 20 hastanın 11’inin (%55) bir doktor veya eczacı tavsiyesiyle kestiği görülmüştür. Sonuç: Çalışmamızın en önemli bulgusu; romatizmal hastalığı olanlarda en yüksek oranda ilaç kesme oranının biyolojik ajan kullanan kişilerde olduğu görülmüştür. Anahtar Sözcükler: Adherens, COVID-19, İmmünsüpresif ilaç, Komplians, Romatolojik Hastalık

Anahtar Kelimeler

• Adherens
• COVID-19
• Komplians
• Romatolojik Hastalık

Kaynakça

1. 1. Marengo MF, Suarez-Almazor ME. Improving treatment adherence in patients with rheumatoid arthritis: what are the options? Int J Clin Rheumtol. 2015;10(5):345–56.
2. 2. Richie D. What Is The Difference Between Adherence Versus Compliance In Patient Behavior? [Internet]. Podiatry Today. 2016 (https://www.podiatrytoday.com/blogged/what-difference-between-adherence-versus-compliance-patient-behavior)
3. 3. Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, Wong PK. Medication compliance and persistence: terminology and definitions. Value Heal J Int Soc Pharmacoeconomics Outcomes Res. 2008;11(1):44–7.
4. 4. Ghannam M, Alshaer Q, Al-Chalabi M, Zakarna L, Robertson J, Manousakis G. Neurological involvement of coronavirus disease 2019: a systematic review. J Neurol. 2020;1–19.
5. 5. Solomou I, Constantinidou F. Prevalence and Predictors of Anxiety and Depression Symptoms during the COVID-19 Pandemic and Compliance with Precautionary Measures: Age and Sex Matter. Int J Environ Res Public Health. 2020;17(14).
6. 6. Cleanthous S, Isenberg DA, Newman SP et al. Patient Uncertainty Questionnaire-Rheumatology (PUQ-R): development and validation of a new patient-reported outcome instrument for systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) in a mixed methods study. Health Qual Life Outcomes. 2016;14:33.
7. 7. Au K, Reed G, Curtis JR, Kremer JM, Greenberg JD, Strand V, Furst DE, CORRONA Investigators. High disease activity is associated with an increased risk of infection in patients with rheumatoid arthritis. Ann Rheum Dis. 2011;70(5):785–91.
8. 8. Jung J-Y, Suh C-H. Infection in systemic lupus erythematosus, similarities, and differences with lupus flare. Korean J Intern Med. 2017;32(3):429–38.

9. 9. Kronbichler A, Jayne DRW, Mayer G. Frequency, risk factors and prophylaxis of infection in ANCA-associated vasculitis. Eur J Clin Invest. 2015;45(3):346–68.
10. 10. Antony A, Connelly K, De Silva T, Eades L, Tillett W, Ayoub S, et al. Perspectives of Patients With Rheumatic Diseases in the Early Phase of COVID-19. Arthritis Care Res (Hoboken). 2020;72(9):1189–95.
11. 11. Türk Romatoloji Derneği. Türkiye Romatoloji Derneği Coronavirüs (Covid-19) Salgını Önerileri [Internet]. 2020 (http://www.romatoloji.org/Haberler/125)
12. 12. Mikuls TR, Johnson SR, Fraenkel L, et al. American College of Rheumatology Guidance for the Management of Rheumatic Disease in Adult Patients During the COVID-19 Pandemic: Version 1. Arthritis Rheumatol (Hoboken, NJ). 2020 Apr;
13. 13.Kamu Hast. Genel Müd., Ted. Plan. Stok ve Lojistik Yön. Daire Bşk., Hast. Ecz. Yön. Birimi. COVID-19 (SARS-CoV2 Enf.) Ted. Kullanılacak İlaçlara İlişkin Bilg. Hidroksiklorokin Sülfat 200 Mg Film Tablet [Internet].