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OpenSAFELY: The impact of COVID-19 on azathioprine, leflunomide and methotrexate monitoring, and factors associated with change in monitoring rate.
Brown, Andrew D; Fisher, Louis; Curtis, Helen J; Wiedemann, Milan; Hulme, William J; Speed, Victoria; Hopcroft, Lisa E M; Cunningham, Christine; Costello, Ruth E; Galloway, James B; Russell, Mark D; Bechman, Katie; Kurt, Zeyneb; Croker, Richard; Wood, Chris; Walker, Alex J; Schaffer, Andrea L; Bacon, Seb C J; Mehrkar, Amir; Hickman, George; Bates, Chris; Cockburn, Jonathan; Parry, John; Hester, Frank; Harper, Sam; Goldacre, Ben; MacKenna, Brian.
Afiliação
  • Brown AD; Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
  • Fisher L; Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
  • Curtis HJ; Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
  • Wiedemann M; Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
  • Hulme WJ; Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
  • Speed V; Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
  • Hopcroft LEM; Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
  • Cunningham C; Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
  • Costello RE; London School of Hygiene and Tropical Medicine, London, UK.
  • Galloway JB; Centre for Rheumatic Diseases, King's College London, UK.
  • Russell MD; Centre for Rheumatic Diseases, King's College London, UK.
  • Bechman K; Centre for Rheumatic Diseases, King's College London, UK.
  • Kurt Z; Northumbria University, Newcastle upon Tyne, UK.
  • Croker R; Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
  • Wood C; Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
  • Walker AJ; Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
  • Schaffer AL; Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
  • Bacon SCJ; Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
  • Mehrkar A; Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
  • Hickman G; Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
  • Bates C; TPP, Leeds, UK.
  • Cockburn J; TPP, Leeds, UK.
  • Parry J; TPP, Leeds, UK.
  • Hester F; TPP, Leeds, UK.
  • Harper S; TPP, Leeds, UK.
  • Goldacre B; Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
  • MacKenna B; Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
Br J Clin Pharmacol ; 2024 Apr 08.
Article em En | MEDLINE | ID: mdl-38589944
ABSTRACT

AIMS:

The COVID-19 pandemic created unprecedented pressure on healthcare services. This study investigates whether disease-modifying antirheumatic drug (DMARD) safety monitoring was affected during the COVID-19 pandemic.

METHODS:

A population-based cohort study was conducted using the OpenSAFELY platform to access electronic health record data from 24.2 million patients registered at general practices using TPP's SystmOne software. Patients were included for further analysis if prescribed azathioprine, leflunomide or methotrexate between November 2019 and July 2022. Outcomes were assessed as monthly trends and variation between various sociodemographic and clinical groups for adherence with standard safety monitoring recommendations.

RESULTS:

An acute increase in the rate of missed monitoring occurred across the study population (+12.4 percentage points) when lockdown measures were implemented in March 2020. This increase was more pronounced for some patient groups (70-79 year-olds +13.7 percentage points; females +12.8 percentage points), regions (North West +17.0 percentage points), medications (leflunomide +20.7 percentage points) and monitoring tests (blood pressure +24.5 percentage points). Missed monitoring rates decreased substantially for all groups by July 2022. Consistent differences were observed in overall missed monitoring rates between several groups throughout the study.

CONCLUSION:

DMARD monitoring rates temporarily deteriorated during the COVID-19 pandemic. Deterioration coincided with the onset of lockdown measures, with monitoring rates recovering rapidly as lockdown measures were eased. Differences observed in monitoring rates between medications, tests, regions and patient groups highlight opportunities to tackle potential inequalities in the provision or uptake of monitoring services. Further research should evaluate the causes of the differences identified between groups.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article