AB1392 COVID-19 HAD AN ADVERSE IMPACT ON DENOSUMAB TREATMENT PROVISION - COMPARISON WITH PRE-PANDEMIC WAITING TIMES AT A UK-BASED RHEUMATOLOGY DEPARTMENT

Abstract

BackgroundDenosumab treatment is licensed for prevention of osteoporotic fractures. It can cause hypocalcaemia, so bone profile blood tests must be checked prior to treatment. In our department, we have a Standard that patients have blood tests within 1 month before their denosumab injection, and that they receive the injection within 1 month from its due date. A customized MS Access database to record this information and generate a date for the next dose was established in 2015 after a quality improvement project (QIP)1. At the onset of the COVID-19 pandemic, UK national guidance recommended continued provision of denosumab as an essential service.Objectives1. To re-audit delay from due date to actual injection date after establishment of our database.2. To compare delay from due date to actual injection date before and after onset of COVID-19.3. To compare the time between blood tests and actual injection date, before and after onset of COVID-19.MethodsData for 2 time-periods were extracted from the database: Time Period 1 (pre-COVID-19) 01-03-2019 – 29-02-2020; Time Period 2 (post-COVID-19 onset) 01-03-2020 – 28-02-2021. For each patient attendance, dates of blood test, due date and actual injection date were extracted. All patient details were anonymised, with a decryption key to identifiers held on a secure server at the host Trust. It was manually determined whether blood tests and injections were within 1 month of when they were due. Statistical analyses were carried out in Stata v.14.0. The Kolmogorov-Smirnov test was used to compare distributions between Time Periods 1 and 2.ResultsTIME PERIOD 1: 100 appointments were audited from 68 patients. 20% of blood tests were within 1 month of actual injection date. Median time between blood tests and actual injection was 45 days [IQR 35 – 59]. 52% of actual injections were given within 1 month from due date. (This compares favourably with our 2015 QIP, when 40% of actual injections were within 1 month from due date1). Median time between due date and actual injection was 29.5 days [IQR 13 – 50.5]. TIME PERIOD 2: 77 appointments were audited from 66 individual patients. 24.7% of blood tests were within 1 month of actual injection. Median time between blood tests and actual injection was 45 days [IQR 35 – 59]. 16.6% of actual injections were given within 1 month of due date. Median time between due date and actual injection was 82 days [IQR 40 – 141]. There were no significant differences in time between blood tests and actual injection between Time Periods 1 and 2. However, the time between due date and actual injection date was significantly longer in Time Period 2 (p<0.005).ConclusionThe introduction of our customized database promoted an improvement in time between due date and actual injection date of denosumab. However, this improvement significantly declined after the onset of the COVID-19 pandemic. Resources may need to be increased and processes adapted to minimise the impact of future emergencies on denosumab provision.