COVID-19 Lockdown Led to Fewer Swiss Patients Adhering to Treatment With Little Impact on Disease Activity

A short interruption in in-person medical visits due to the COVID-19 pandemic significantly decreased treatment adherence but had little impact on disease activity in people with axial spondyloarthritis (axSpA), according to a real-life study in Switzerland.

Notably, these parameters returned to pre-pandemic levels in the post-lockdown period.

Similar trends were found for people with other inflammatory rheumatic diseases, such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA), but these did not reach statistical significance.

The study, “Impact of the COVID-19 pandemic on the disease course of patients with inflammatory rheumatic diseases: results from the Swiss Clinical Quality Management cohort,” was published in the journal Annals of the Rheumatic Diseases.

The temporary lockdown that was part of the pandemic containment measures led to partial or complete closure of rheumatology services in several countries. This affected many aspects of patient care, from in-person visits to treatment initiation and surgeries.

Whether telemedicine helped to compensate for the lower number of face-to-face visits and prevented delays in treatment decisions and disease worsening remains unclear. Telemedicine is the use of technology — such as computers, telephones, or smartphones — to connect patients directly with a healthcare professional.

In addition, fearful of COVID-19-associated complications, some patients may have chosen to preventively stop immunosuppressive therapies, thereby affecting their disease management.

In the study, researchers set out to assess whether the reduction in rheumatology services imposed by COVID-19 containment measures in Switzerland was associated with disease worsening in 287 axSpA patients, 248 RA patients, and 131 PsA patients.

All participants were included in the Swiss Clinical Quality Management registry, a national data set of people with inflammatory rheumatic diseases.

The team evaluated patients’ disease course and treatment adherence before, during, and after the first wave of COVID-19 in Switzerland using patient-reported data from in-person visits and/or a web-based smartphone application (implemented in the Swiss registry in January 2019).

Based on the progress of COVID-19 infection numbers in the country, the three periods were defined as: pre-COVID-19 from Jan. 1 to Feb. 29, the first wave from March 1 to April 30, and post-COVID-19 from May 1 to June 30.

The mean age for the group of axSpA patients was 47.1 years, and they had been living with the disease for a mean of 17.4 years. Most (70.7%) were on biologic therapies, and four (1.4%) became infected with COVID-19. Their disease activity was measured through the Bath Ankylosing Spondylitis Disease Activity Index.

All patients giving answers other than “yes” to the question “Do you take the following medication regularly?” in the monthly app questionnaire were considered non-adherent to treatment.

Results from all three groups showed that the number of in-person visits dropped by 52% — from 543 consultations in February to 262 in April — while the number of remote assessments through the app increased by 129% (from 521 to 1,195).

The proportion of axSpA patients not adhering to treatment significantly increased from 13.2% to 19.9% during the first wave, but dropped to 10.1% post-COVID-19. In addition, people with axSpA showed a significant decrease in disease activity during the first wave, but not in the post-wave period.

Similar trends were observed for RA and PsA patients, but they did not reach statistical significance.

Notably, the rate of disease flares remained stable under 15% for all three patient groups across all time periods.

“We hypothesise that the duration of the pandemic was too short for the documented transient decrease in [treatment] adherence to be reflected in an increase in disease flares,” the researchers wrote.

The team added, however, that the study was limited to patients with regular assessment of disease activity, mostly done using the app. Such patients can be more invested in disease management, thereby likely underestimating the real proportion of people not adhering to treatment.

“A temporary interruption of in person consultations during the COVID-19 pandemic had no major detrimental impact on the disease course of patients with inflammatory rheumatic diseases as assessed through patient-reported outcomes,” the team concluded.

While it is unclear how much patients interacted with their physicians also through email and phone calls, the researchers emphasized that telemedicine played a significant role in the study’s outcomes.

In the absence of alternatives, the use of patient-reported outcomes during periods of suspended face-to-face visits is warranted, the researchers added. Future studies are needed to determine the usefulness of remote strategies to regularly assess patient-reported outcomes.