POS1485-HPR PATIENTS’ PERSPECTIVE ON CONTINUATION VERSUS TEMPORARY INTERRUPTION OF IMMUNOMODULATORY AGENTS DURING INFECTIONS IN PATIENTS WITH IMMUNE-MEDIATED INFLAMMATORY DISEASES: AN INTERVIEW STUDY

Abstract

Background:Immune mediated inflammatory diseases (IMIDs) like rheumatoid arthritis (RA) are often treated with immunomodulatory agents (IA). Infection risks appear to be slightly increased in IMID patients using IA1. However, it remains uncertain whether it is best to continue or temporary interrupt IA in case of an infection For this decision, it is essential to know patient’s perceptions about both strategies. Unfortunately, little is known about the patients’ perceptions on this topic.Objectives:To explore the patients’ perspectives on continuation and temporary interruption of IA in case of an infection and assess possible barriers and facilitators.Methods:Semi-structured interviews were conducted in IMID patients using IA. Patients were recruited from the rheumatology, dermatology and gastroenterology departments of two hospitals in the Netherlands. Purposive sampling was used to select a diverse patient population. Semi-structured interviews were performed until data saturation was reached and analyzed using inductive thematic analysis.Results:19 patients with 6 different IMIDs and 17 different IA were interviewed. The majority was female, mean age 51 years and mean disease duration 17 years. Four had experienced a severe infection (requiring hospitalization). 15 patients indicated that they would prefer to continue their IA in case of an infection, however, for most patients this would depend on the infection severity. Several facilitators and barriers were identified (Table 1). Patients mentioned disease flare as a barrier for temporary interruption. Beliefs about susceptibility to infections form barriers and facilitators for both temporary interruption and continuation. Patients also mentioned that they would follow their physician’s advice on continuation/temporary interruption.Table 1.Identified barriers and facilitatorsTemporary interruptionBarriersDisease flare and its impactLoss of IA effects or increased side effects after restartingLong duration of interruptionBelief: IA has no/a positive effect on infection (risk)Belief: not more susceptible for infectionsPractical barriersNot aware of possibility of interruptionNot following physician’s adviceFacilitatorsMore severe and/or longer lasting infectionInteractions with medication needed for infectionPositive effect of interruption on immune systemShort duration of interruptionBelief: more susceptible for infectionsBelief: IA has a negative effect on infection (risk)Concerned about infectionsCurrent stable diseasePhysician’s adviceLong duration of IA effectsWish to taper/stop IA in generalNegative impact of infection on daily activitiesContinuationBarriersBelief: more susceptible for infectionsBelief: IA has a negative effect on infection (risk)Negative previous experiences during infectionLoss of IA effects after long useInteractions with medication needed for infectionFacilitatorsBelief: not more susceptible for infectionsBelief: IA has no/a positive effect on infection (risk)Not concerned about infectionsIA needed to control IMIDMild infectionPositive previous experiences with continuationPhysician’s adviceConclusion:Interviewed patients seemed to prefer continuation of IA during an infection if possible. The concern of disease flare might form a barrier for temporary interruption, this is in line with a previous study, showing that RA patients fear disease flare after dose reduction 2.