DMARD Changes for Patients with Rheumatoid Arthritis in the US During the COVID-19 Pandemic: A 3-Month Observational Study.

Objective To understand medication, lifestyle, and clinical care changes by persons with RA during the first months (March through May 2020) of the COVID-19 pandemic in the US. Methods Data were provided by adults with RA participating in FORWARD, The National Databank for Rheumatic Diseases, observational registry who answered COVID-19 web-based surveys in May 2020 and previously provided baseline (pre-COVID) characteristics and medication use. We compared medication changes by DMARD exposure in logistic models adjusting for age, sex, comorbidities including pulmonary and cardiovascular diseases, education, health insurance, RA activity, fatigue, and polysymptomatic distress. Results Of 734 respondents, 221 (30%) reported medication changes. Changers more commonly used glucocorticoids (GCs) (33% vs 18%) and less commonly used non-hydroxychloroquine conventional DMARDs (49% vs 62%) pre-COVID and reported more economic hardship during COVID (23% vs 15%). While JAK inhibitor use was associated (OR 1.9 [95%CI 1.0, 3.4]) with change, only pre-COVID GCs remained a strong predictor (OR 3.0 [1.9, 4.9]) in multivariable models. Change in care was significantly associated with pulmonary disease (OR 2.9 [1.3, 6.5]), worse RA activity (OR 1.1 [1.0, 1.1]), and GC use (OR 1.6 [1.0, 2.5]). While the incidence of medication change before and after ACR guidelines were published was the same, self-imposed changes were approximately twice as likely before, and physician guided changes were more likely after. Conclusion Persons with RA in the US made substantial medication changes during the first three months of the COVID-19 pandemic. Changes after publication of ACR recommendations were made with increased physician guidance.