Managing patients with rheumatic diseases during the COVID-19 pandemic: The French Society of Rheumatology answers to most frequently asked questions up to May 2020

Richez, Christophe; Flipo, R.M.; Bérenbaum, Francis; Cantagrel, Alain; Claudepierre, Pascal; Debiais, Françoise; Dieudé, Philippe; Goupille, Philippe; Roux, Christian; Schaeverbeke, Thierry; Wendling, Daniel; Pham, Thao; Thomas, Thierry

doi:10.1016/j.jbspin.2020.05.006

Cited by 23 publications

(22 citation statements)

References 36 publications

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“…The task force agrees that it is logical to sustain treatment with these drugs among patients who have ongoing indications for their use except if there are other clinical reasons for discontinuation. This is similar to the position of other professional rheumatology bodies in Europe and America [3,17].…”

Section: Statement 15supporting

confidence: 83%

“…Recognizing the risk of adrenal suppression and the uncertain benefit of aggressive steroid tapering or withdrawal led to the task force agreeing on sustaining glucocorticoid treatments albeit at doses not more than required to keep treated conditions controlled. This seems to align with the recommendations of other international associations of rheumatology [2][3][4]17].…”

Section: Statement 11supporting

confidence: 81%

“…It soon became clear that the scanty amount and low quality of existing evidence on various relevant clinical questions as well as the lengthy duration needed for its execution made it an unworthy venture to proceed with. While a number of useful insights were drawn from the recommendations of national and international rheumatology societies outside Africa, aspects that are specific to paediatric rheumatology were excluded in most of these [2][3][4]17]. However, the structure of AFLAR and the gradually growing membership of the PAFLAR usefully identified the need to work together to produce a common document in view of potential substantial overlaps in the relevant aspects of recommendation for adults and children in the era of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

“…Whereas NSAIDs should generally be used in the lowest effective dose, the use in patients who go on to develop COVID-19 should be based on a favourable risk-benefit ratio [3,16]. Certainly, there is currently no evidence-backed contraindication to the use of NSAIDs in the patient who is at risk of COVID19 [17].…”

Section: Statementmentioning

confidence: 99%

“…The recommendation of both the American Heart Association and the European Society for Cardiology is to sustain treatment with these drugs in patients on them [22,23]. This is also t h e r e c o m m e n d a t i o n o f th e F r e n c h S o c i e t y o f Rheumatology [17].…”

Section: Statement 9 Aceis and Arbs Should Not Be Routinely Discontinmentioning

confidence: 99%

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African League Against Rheumatism (AFLAR) preliminary recommendations on the management of rheumatic diseases during the COVID-19 pandemic

et al. 2020

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Objectives To develop recommendations for the management of rheumatic and musculoskeletal diseases (RMDs) during the COVID-19 pandemic. Method A task force comprising of 25 rheumatologists from the 5 regions of the continent was formed and operated through a huband-spoke model with a central working committee (CWC) and 4 subgroups. The subgroups championed separate scopes of the clinical questions and formulated preliminary statements of recommendations which were processed centrally in the CWC. The CWC and each subgroup met by several virtual meetings, and two rounds of voting were conducted on the drafted statements of recommendations. Votes were online-delivered and recommendations were pruned down according to predefined criteria. Each statement was rated between 1 and 9 with 1-3, 4-6 and 7-9 representing disagreement, uncertainty and agreement, respectively. The levels of agreement on the statements were stratified as low, moderate or high according to the spread of votes. A statement was retired if it had a mean vote below 7 or a 'low' level of agreement. Results A total of 126 initial statements of recommendations were drafted, and these were reduced to 22 after the two rounds of voting. Conclusions The preliminary statements of recommendations will serve to guide the clinical practice of rheumatology across Africa amidst the changing practices and uncertainties in the current era of COVID-19. It is recognized that further updates to the recommendations will be needed as more evidence emerges. Keywords African rheumatology. COVID-19. DMARD. Rheumatic and musculoskeletal diseases. Rheumatology Key Points • AFLAR has developed preliminary recommendations for the management of RMDs in the face of the COVID-19 pandemic. • COVID-19 is an unprecedented experience which has brought new concerns regarding the use of some disease-modifying anti-rheumatic drugs (DMARDs), and these recommendations seek to provide guidelines to African rheumatologists. • Hydroxychloroquine shortage has become rampant across Africa as the drug is being used as prophylaxis against COVID-19 and this may necessitate a review of the treatment plan for some patients with RMDs. • Breastfeeding should continue for as long as possible if a woman is positive for SARS-CoV-2 as there is currently no evidence that the infection can be transmitted through breast milk. This article is part of the Topical Collection on Rheumatology in Africa

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Section: Statement 15supporting

confidence: 83%

Section: Statement 11supporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Statementmentioning

confidence: 99%

Section: Statement 9 Aceis and Arbs Should Not Be Routinely Discontinmentioning

confidence: 99%

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African League Against Rheumatism (AFLAR) preliminary recommendations on the management of rheumatic diseases during the COVID-19 pandemic

et al. 2020

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COVID-19: What Do Rheumatologists Need to Know?

2021

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Perspectives on Subcutaneous Infliximab for Rheumatic Diseases and Inflammatory Bowel Disease: Before, During, and After the COVID-19 Era

et al. 2022

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Graphical Abstract The coronavirus disease 2019 (COVID-19) pandemic has prompted significant changes in patient care in rheumatology and gastroenterology, with clinical guidance issued to manage ongoing therapy while minimising the risk of nosocomial infection for patients and healthcare professionals (HCPs). Subcutaneous (SC) formulations of biologics enable patients to self-administer treatments at home; however, switching between agents may be undesirable. CT-P13 SC is the first SC formulation of infliximab that received regulatory approval and may be termed a biobetter as it offers significant clinical advantages over intravenous (IV) infliximab, including improved pharmacokinetics and a convenient mode of delivery. Potential benefits in terms of reduced immunogenicity have also been suggested. With a new SC formulation, infliximab provides an additional option for dual formulation, which enables patients to transition from IV to SC administration route without changing agent. Before COVID-19, clinical trials supported the efficacy and safety of switching from IV to SC infliximab for patients with rheumatoid arthritis and inflammatory bowel disease (IBD), and SC infliximab may have been selected on the basis of patient and HCP preferences for SC agents. During the pandemic, patients with rheumatic diseases and IBD have successfully switched from IV to SC infliximab, with some clinical benefits and high levels of patient satisfaction. As patients switched to SC therapeutics, the reduction in resource requirements for IV infusion services may have been particularly welcome given the pandemic, facilitating reorganisation and redeployment in overstretched healthcare systems, alongside pharmacoeconomic benefits and a reduction in exposure to nosocomial infection. Telemedicine and contactless healthcare have been pushed to the forefront during the pandemic, and a lasting shift towards remote patient management and community/home-based drug administration is anticipated. SC infliximab supports the implementation of this paradigm for future improvements of healthcare value delivered. The accumulation of real-world data during the pandemic supports the high level of confidence, with patients, physicians, and healthcare systems benefitting from its uptake.

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Managing patients with rheumatic diseases during the COVID-19 pandemic: The French Society of Rheumatology answers to most frequently asked questions up to May 2020

Cited by 23 publications

References 36 publications

African League Against Rheumatism (AFLAR) preliminary recommendations on the management of rheumatic diseases during the COVID-19 pandemic

African League Against Rheumatism (AFLAR) preliminary recommendations on the management of rheumatic diseases during the COVID-19 pandemic

COVID-19: What Do Rheumatologists Need to Know?

Perspectives on Subcutaneous Infliximab for Rheumatic Diseases and Inflammatory Bowel Disease: Before, During, and After the COVID-19 Era

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