| Title: |
OpenSAFELY: The impact of COVID-19 on azathioprine, leflunomide and methotrexate monitoring, and factors associated with change in monitoring rate. |
| Authors: |
Brown, Andrew D; Fisher, Louis; Curtis, Helen J; Wiedemann, Milan; Hulme, William J; Speed, Victoria; Hopcroft, Lisa EM; 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 CJ; Mehrkar, Amir; Hickman, George; Bates, Chris; Cockburn, Jonathan; Parry, John; Hester, Frank; Harper, Sam; Goldacre, Ben; OpenSAFELY Collaborative; MacKenna, Brian |
| Publisher Information: |
Wiley |
| Publication Year: |
2024 |
| Collection: |
London School of Hygiene & Tropical Medicine: LSHTM Research Online |
| Description: |
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. |
| Document Type: |
article in journal/newspaper |
| File Description: |
text |
| Language: |
English |
| ISSN: |
0306-5251 |
| Relation: |
https://researchonline.lshtm.ac.uk/id/eprint/4672208/9/Brown_etal_2024-OpenSAFELY-the-impact-of-COVID%E2%80%9019-on-azathioprine-leflunomide-and-methotrexate.pdf; Brown, Andrew DORCID logo; Fisher, Louis; Curtis, Helen J; Wiedemann, Milan; Hulme, William J; Speed, VictoriaORCID logo; Hopcroft, Lisa EM; Cunningham, Christine; Costello, Ruth E ORCID logo; Galloway, James B; +18 more.Russell, Mark D; Bechman, Katie; Kurt, Zeyneb; Croker, Richard; Wood, ChrisORCID logo; Walker, Alex J; Schaffer, Andrea LORCID logo; Bacon, Seb CJ; Mehrkar, Amir; Hickman, George; Bates, Chris; Cockburn, Jonathan; Parry, John; Hester, Frank; Harper, Sam; Goldacre, Ben ORCID logo; OpenSAFELY Collaborative; and MacKenna, Brian (2024) OpenSAFELY: The impact of COVID-19 on azathioprine, leflunomide and methotrexate monitoring, and factors associated with change in monitoring rate. British Journal of Clinical Pharmacology, 91 (6). pp. 1586-1599. ISSN 0306-5251 DOI:10.1111/bcp.16062 |
| DOI: |
10.1111/bcp.16062 |
| Availability: |
https://researchonline.lshtm.ac.uk/id/eprint/4672208/; https://doi.org/10.1111/bcp.16062 |
| Rights: |
cc_by_4 |
| Accession Number: |
edsbas.EE9B2763 |
| Database: |
BASE |