Clinical Rheumatology Unit, ASST Gaetano Pini-CTO, Department of Clinical Sciences & Community Health, Università degli Studi di Milano, Milano, Italy.
Lab of Medical Statistics, Biometry and Epidemiology "GA Maccacaro", Department of Clinical Sciences & Community Health, Università degli Studi di Milano, Milano, Italy.
J Telemed Telecare. 2024 Oct;30(9):1445-1453. doi: 10.1177/1357633X221150724. Epub 2023 Jan 24.
To analyze the impact of different patterns of healthcare delivery on remission of rheumatoid arthritis (RA) patients treated with targeted therapies during the first wave (2020) and second/third waves (2021) of the pandemic compared to the pre-pandemic period (2019).
In this observational real-life study, data from RA patients treated with biologic or targeted synthetic drugs were extracted from a longitudinal registry. Clinical Disease Activity Index (CDAI) was analyzed in the same period from the 22nd of February to the 18th of May for three consecutive years. These three periods were characterized by different patterns of healthcare delivery: (1) before the pandemic (2019) only in-person visits, (2) during the first wave (2020) both in-person visits and telehealth, and (3) during the second/third waves (2021) only in-person visits. A generalized linear model with the binomial error was fitted to evaluate the difference in the proportion of patients in CDAI remission. Quantile regression was used to compare the median of CDAI in difficult-to-treat (D2T) patients.
In the three periods, we included 407, 450, and 540 RA patients respectively. The percentages of patients in CDAI remission were similar in the three periods (prevalence ratio 1.07, p value 0.423 between 2020 and 2019, and 1.01, p-value 0.934 between 2021 and 2019). The CDAI remission rate was 40.55% ( = 163), 43.18% ( = 155) and 40.82% ( = 220) in 2019, 2020 and 2021, respectively. Among our cohort of D2T patients, CDAI remission was similar across the three periods ( = 30, 22.22%; = 27, 23.68%; and = 34, 21.52% respectively).
Although the pandemic has imposed changes in our healthcare delivery, these different strategies seem to be effective in ensuring satisfactory management of RA treated with targeted therapies. The approaches modulated in the context of the different periods have been a feasible compensation for ensuring disease control even in D2T patients.
分析在疫情第一波（2020 年）和第二/第三波（2021 年）期间，与大流行前时期（2019 年）相比，不同医疗模式对接受靶向治疗的类风湿关节炎（RA）患者缓解的影响。
在这项观察性真实世界研究中，从纵向登记处提取了接受生物制剂或靶向合成药物治疗的 RA 患者的数据。在连续三年的 2 月 22 日至 5 月 18 日期间，分析相同时间段的临床疾病活动指数（CDAI）。这三个时期的医疗模式不同：（1）大流行前（2019 年）仅为面对面就诊，（2）第一波（2020 年）既包括面对面就诊也包括远程医疗，（3）第二/第三波（2021 年）仅为面对面就诊。使用二项误差的广义线性模型评估 CDAI 缓解患者比例的差异。使用分位数回归比较难治性（D2T）患者的 CDAI 中位数。
在三个时期中，我们分别纳入了 407、450 和 540 名 RA 患者。三个时期的 CDAI 缓解患者比例相似（2020 年与 2019 年的患病率比为 1.07，p 值为 0.423，2021 年与 2019 年的患病率比为 1.01，p 值为 0.934）。2019 年、2020 年和 2021 年的 CDAI 缓解率分别为 40.55%（ = 163）、43.18%（ = 155）和 40.82%（ = 220）。在我们的 D2T 患者队列中，三个时期的 CDAI 缓解情况相似（ = 30，22.22%； = 27，23.68%； = 34，21.52%）。
尽管大流行改变了我们的医疗服务模式，但这些不同的策略似乎有效地确保了接受靶向治疗的 RA 的治疗管理令人满意。在不同时期调整的方法为确保疾病控制提供了可行的补偿，即使是在 D2T 患者中也是如此。
