LAUSR

Background: Rheumatic patients' follow-up in terms of treatment adherence, disease control achieved with treat-to-target (T2T) and tight-control strategy have been deeply influenced by nationwide mitigation strategies such as quarantine, travel restrictions, and inadequate access to routine visits, laboratory and imaging investigations. These restrictions could be potentially detrimental for patients' care, but to what extent these measures affected the T2T and tight-control approach in rheumatoid arthritis (RA) is unknown. Objectives: This study investigated whether the adoption of telephone virtual care imposed by COVID-19 pandemic has been effective in maintaining remission in RA treated with targeted therapies and to identify factors associated with its maintenance. Methods: This observational retrospective real-life study was conducted from November 2019 through September 2020. Clinical Disease Activity Index (CDAI) of RA patients treated with targeted therapies was analysed retrospectively before, during and after the national lockdown (LD). During LD period, rheumatologists provided virtual care by telephone to assess the clinical status to guarantee the absence of current contraindications to therapy. Then, patients could choose whether to receive home drug delivery or to maintain their faceto-face consultations. Logistic mixed effects regression models were fitted, with CDAI remission as response variable. A multivariate analysis and a parsimonious model were finally obtained by stepwise selection procedure using AIC. Results: Data were extracted from a longitudinal observational registry, and at baseline, 502 RA patients were eligible for this study. 52 patients failed to complete their follow-up, 450 patients were included in the final analysis. During LD, 359 patients chose in-person visit, 91 patients home drug delivery and virtual visit. Our cohort did not show a statistically significant decrease in the number of patients fulfilling CDAI remission criteria all along the three periods. Among the 450 patients evaluated, the CDAI remission rate was 40.22% (N=181) and 43.78% (N=197) during pre-LD and post-LD, respectively. As for the 359 patients who choose in-person visits during LD, 43.18% (N=155) were in remission according to CDAI. The final model (step-wise selection) applied to the multivariate analysis of factors that potentially could interfere with disease control in patients with CDAI remission showed that the probability to maintain remission was associated with Caucasian ethnicity, male gender and absence of fibromyalgia (Table 1 below). Conclusion: Telephone-based tight control strategy ensured satisfactory management of RA treated with targeted therapies during the first wave of COVID-19 pandemic. All along the three periods, we observed that the probability to be in CDAI remission was significantly associated with Caucasian ethnicity, male gender, and absence of fibromyalgia. This temporary approach has been a feasible compensation for face-to-face visits, thus reassuring for future months before the end of pandemic.