Most Adhered to Treatment During COVID-19 Lockdowns

About one-third of patients with ANCA-associated vasculitis (AAV) or other forms of vasculitis postponed at least one of their healthcare visits during the first months of the COVID-19 pandemic, but most continued adhering to treatment, a survey reveals.

Moreover, patients with vasculitis are complying with advice to stay at home as much as possible, which might explain the low occurrence of COVID-19 in those surveyed.

Patients with AAV often take immunosuppressants that weaken their immune systems, and initial concerns that these medications could increase the risk of contracting COVID-19 have presented challenges to treatment compliance.

However, “considering the complications due to possible disease flares, treatment compliance is an important issue,” the researchers wrote.

To understand the impact of the COVID-19 pandemic on treatment compliance, the researchers analyzed data from 103 patients with ANCA-associated and large vessel vasculitis who were being followed at the Department of Rheumatology at Istanbul Faculty of Medicine.

The patients were contacted by telephone, March 1 to June 30, 2020, and asked to provide answers to a series of 11 questions.

When asked about the type of treatment received, 54 (52.4%) patients said they took oral medications, 41 (39.8%) received parenteral (non-oral) medications, and eight (7.8%) did not take any medications; 85 (82.5%) were on corticosteroids and 35 (33.9%) received intravenous (into-the-vein) treatment requiring periodic hospital admissions.

At the time of the survey, 33 patients (32%) had missed at least one visit during the first months of the pandemic. Patients receiving parenteral medications were three times more likely to comply with the appointment schedule compared with those taking oral medications.

In accordance with lockdown rules, 98 patients (95.1%) said they had spent the previous three months at home.

When asked about treatment compliance, five patients (4.8%) said they did not take their immunosuppressants regularly during the previous three months. Three patients (2.9%) developed symptoms due to insufficient treatment.

In general, patients are aware “about the clinical course of their disease and their use of oral treatment options,” the researchers wrote.

Four patients (3.9%) were admitted to the hospital with complaints such as fever, cough, shortness of breath, abnormal smell or taste, abdominal pain, and diarrhea. However, none of them tested positive for the virus causing COVID-19.

One patient with granulomatosis with polyangiitis (a type of AAV) was diagnosed with COVID-19 during hospitalization for a disease flare; the patient died despite treatment.

These data are in line with a recent study that found that the occurrence of COVID-19 among patients with AAV is similar to that of the general population.

“Although outpatient appointments were postponed in one-third of our patients, high compliance with treatment and isolation rules ensured patients with vasculitis overcome this period with minimal morbidity and mortality,” the researchers concluded.