Data regarding COVID-19 vaccine efficacy and adverse events (AE) in patients with autoimmune and inflammatory rheumatic diseases (AIIRD) have been published recently although these mostly include the mRNA vaccines (Pfizer-BioNTech and Moderna) and the ChAdOx1 nCoV-19/AZD1222 (Oxford-AstraZeneca). This research aimed to study the prevalence of AE presented with six different SARS-CoV-2 vaccines {ChadOX1 nCoV-19 (AZD1222), Ad5-nCoV2, Ad26.COV2.S, mRNA-1273, BNT162b2, and CoronaVac} in Mexican patients with AIIRD. We performed a cross-sectional study about vaccine history. Two hundred and twenty five consecutive patients were recruited, mean age was 50.7 years and the majority (n = 213; 94.6%) were females. One hundred and seven (47.5%) received BNT162b2 mRNA, 34 (15.1%) Ad5-nCoV, 29 (12.8%) mRNA-1273, 28 (12.4%) ChAdOX1 nCoV-19 (AZD1222), 22 (9.7%) CoronaVac and 5 (2.2%) Ad26.COV2.S. The vaccines that had the most AE proportionally to the number of patients vaccinated were Janssen (5; 100%) followed by Pfizer-BioNTEch (86; 80%) and CanSinoBIO (27; 79.4%). Localized pain was the most frequent (158; 70.2%) AE. Fatigue (78; 34.7%), headache (69; 30.6%) and muscle ache (66; 29.3%) were the most common systemic symptoms. No serious AE that required medical attention or hospitalization were reported. The current results support the safety of different COVID-19 vaccines in patients with AIIRD. This information can help fight vaccine hesitancy in this population. KeywordsCOVID-19 vaccines • SARS-CoV-2 • Vaccine hesitancy • Autoimmune rheumatic diseases • Drug-related side effects and adverse reactions Rheumatology INTERNATIONAL
Background:One of the greatest challenges of the COVID-19 pandemic for rheumatologists concerns the patient’s adherence to treatment (1). The impact of poor adherence on the effectiveness of chronic disease treatment is severe in terms of poorer health outcomes and increased health care costs (2). Information regarding covid-19 on adherence behavior in Latin-American is scarce.Objectives:The aim of this study is to describe impact of COVID-19 outbreak on adherence behavior in Latin-American population with rheumatic diseases.Methods:We carried out a descriptive, cross-sectional, self-report study through voluntary telephonic survey, to determine adherence behaviors during the COVID-19 pandemic, from September 9th, 2020 to November 19th, 2020, for consecutive patients of the outpatient rheumatology clinic in the Hospital Universitario (Monterrey, Nuevo Leon, Mexico), which serves a resource limited population that lack access to health insurance, from five neighboring states. A 17-items survey was designed. Baseline demographics that were collected included age, sex, rheumatologic diagnosis, current medications and patient perception of disease control. Patients were asked if they continued follow-up care, last prescribed therapy and reasons. Also, the survey assessed whether patients had any issues with medication supply and where they were obtaining information about covid-19 (could choose as many options as applicable). Transferred to SPSS for analysis for descriptive statistics.Results:A total of 150 patients were called, the survey response rate was 54.6% (n=82), with a mean completion time of 10 minutes. The mean +/- SD age of the participants was 52 +/- 15.9 years, and 95% were female. The most common self-reported diagnoses were rheumatoid arthritis (RA) (13.4%) and systemic lupus erythematosus (SLE) (13.4%) [Table 1]. Patient perception of disease control was primary good 37.8% and regular 35.4%.Patients that continued their follow-up with their rheumatologist (on the clinic face-to-face, electronically or telehealth) or in another clinic were 26.9%, the majority were nonadherent 73%. Persistence to treatment was 82.9%, the main reason to discontinue therapy was lack of prescriptions or medical advice 8.5% and overall 58.5% had trouble finding their medicine.Information regarding covid-19 was mainly obtained by television (health secretary conference) 90.2%, and the least directly from their doctor 4.8%.Table 1.Survey ResultsN (%)Age, mean +/- SD years 52 +/- 15.9Female/ Male78 (95.1) / 4 (4.9)DiagnosesRA50(61)SLE11(13.4)Osteoarthritis10(12.2)Other11(13.4)Disease Control during covid-19Excellent8 (9.8)Good31 (37.8)Regular29 (35.4)Bad14 (17.1)Continued follow-up(face-to-face, telehealth, other)22 (26.9)Continued last prescribed treatment68 (82.9)Reasons to discontinue treatmentLack of prescriptions/ medical advice7 (8.5)Lack of availability6(7.3)Economic disadvantage3 (3.6)Fear of getting sick of COVID-192(2.4)“Trouble” finding medicine48 (58.5)COVID-19 informationTelevision (Health Secretary conference)74 (90.2)Social network27 (32.9)Newspaper/ magazines14 (17)Internet9 (10.9)From a doctor4 (4.8)Conclusion:Patients continue their therapeutic regimen, still many of them have trouble finding their medications, which affects the disease control. Also, despite having a poor disease control (majority between regular and bad) they are not continuing their follow-up care, more objective studies are needed to determine a specific cause.References:[1]Pineda-Sic RA, Galarza-Delgado DA, Serna-Pena G, et al. Ann Rheum Dis Epub ahead of print: [20-06-2020]. doi:10.1136/ annrheumdis-2020-218198[2]Anghel, L. A., Farcaş, A. M., & Oprean, R. N. (2018). Medication adherence and persistence in patients with autoimmune rheumatic diseases: a narrative review. Patient preference and adherence, 12, 1151–1166. https://doi.org/10.2147/PPA.S165101Disclosure of Interests:None declared
Background:The pandemic COVID-19 has set a new challenge in adherence to treatment in patients with rheumatic diseases. Prior studies in Latin America had reported adherence of 16.4% on Rheumatoid Arthritis (RA) and 45.9% in Systemic Lupus Erythematous (SLE). There is evidence that these patients believe their treatment increases the risk and gravity of COVID-19 and therefore, suspending the treatment could reduce this risk. It has been shown that a “Good adherence” is associated to a better survival.Objectives:Describe the adherence to DMARDs in patients with Rheumatic diseases during COVID-19.Methods:Descriptive, cross-sectional, self-report study conducted in rheumatology outpatient clinic of University Hospital in Monterrey, México. Consecutive patients with RA, SLE, Inflammatory Myopathies and Systemic Sclerosis, were approached during their routine appointments, March 2020 to December 2020 period during COVID-19 pandemic. They were asked how many days of the month they took the DMARD indicated in the previous appointment, with Based on this, adherence was classified into four categories: Good 100-75% (> 21 days), Regular 74-50% (21-15 days), Bad 49-25% (14-8 days) and Null <25% (<7 days). Data was obtained from our internal electronic patient record registry and analyzed with SPSS V.22.Results:n (DMARDs)GoodRegularBadNulln (%)n (%)n (%)n (%)Rheumatoid Arthritis302255 (84.4)13 (4.3)20 (6.6)14 (4.6)Systemic Lupus Erithematous126111 (88)3 (2.3)8 (6.3)4 (3.1)Inflammatory Myopathies1110 (90.9)0 (0)1 (9)0 (0)Systemic Sclerosis3027 (90)2 (6.6)1 (3.3)0 (0)TOTAL469Conclusion:Despite what it is believed, patients are not changing therapeutic regimes. The adherence found in this group of patients was good, for the definition used in this study. It should be considered that the self-report method may overestimate adherence, so the data found must be correlated with objective methods in the future.References:[1]Resende Prudente L, Souza Diniz J, Matteucci Ferreira TXA, Marçal Lima D, Antônio Silva N, Saraiva G, et al. Medication adherence in patients in treatment for rheumatoid arthritis and systemic lupus erythematosus in a university hospital in Brazil. Patient Preference and Adherence. 2016:10 863–870.[2]Michaud K, Wipfler K, Shaw Y, et al. Experiences of patients with rheumatic diseases in the United States during early days of the COVID-19 pandemic. ACR Open Rheumatol 2020. doi:10.1002/acr2.11148.[3]Waimann ChA, Marengo MF, de Achaval S, Cox VL, Garcia-Gonzalez A, Reveille JD. Electronic Monitoring of Oral Therapies in Ethnically Diverse and Economically Disadvantaged Patients With Rheumatoid Arthritis. Arthritis & Rheumatism. 2013:6 1421-1429.Disclosure of Interests:None declared
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