AB1091 THE IMPACT OF COVID-19 PANDEMIC ON DISEASE MONITORING AND MONITORING FOR ADVERSE CLINICAL OUTCOMES IN THOSE ON BIOLOGIC THERAPY.

Abstract

BackgroundThe coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2.1 The pandemic has posed major challenges to the National Health Service, with implications for patients with rheumatological diseases. 2 In order to try and prevent transmission of the virus, the delivery of patient care has adapted, involving more telephone and virtual review of patients. The British Society of Rheumatology (BSR) has highlighted the importance of adopting a ‘treat-to-target’ 3 approach in managing these patients to facilitate early treatment escalation in the presence of active disease. Close monitoring of disease is an integral approach to managing these patients. Disruption to previous patterns of care and disease monitoring of biologic patients theoretically may increase the risk of disease flare and adverse clinical outcomes. 4ObjectivesThe BSR recommends all patients receiving biologic therapy should be reviewed for drug safety every 6 months. It recommends that patients prescribed a biologic should have monitoring blood tests every 3–6 months.3, 5 The BSR has published mitigating guidance outlined within the COVID-19 rapid guideline.5 This suggests it’s safe to increase time intervals between blood tests for drug monitoring, particularly if 3-monthly blood tests have been stable for over 2 years.Our aims are to evaluate whether altering our delivery of care has impacted on the ‘treat-to-target’ approach and the frequency of blood monitoring in those on biologic therapy, despite the challenges of an ongoing global pandemic.MethodsOver a period of 1 month a total of 51 patients receiving biologic therapy case notes were reviewed. Data was collected relating to underlying diagnosis, choice of biologic, whether a disease activity score was performed, method of consult and compliance with drug monitoring.ResultsOf the 51 patients 24 patients were receiving adalimumab, 20 baricitinib, 2 filgotinib, 2 upadacitinib and 3 on entarcept. Diagnoses ranged from 33 patients with rheumatoid arthritis, 7 psoriatic arthritis, 5 ankylosing spondylitis, 5 spondyloarthropathy and 1 enteropathic arthritis. Disease activity scores were documented in the majority of patients (75%). In those where disease activity scores were not documented, 11 had rheumatoid arthritis and the remaining 2 psoriatic arthritis. The majority of the patients who didn’t have disease activity scores documented were reviewed via telephone consult (84%). All patients had undergone adequate blood monitoring with 100% compliance with blood tests performed within 6 months.ConclusionThe COVID-19 pandemic has presented an extraordinary necessity for change in how we manage patients suffering from rheumatic disease. The impact of this global pandemic will be long-lasting and thorough analysis of patient outcomes is needed. However, this period presents an exciting opportunity to embrace new ways of working, which may improve efficiency and efficacy of patient care.