The following advice is for the management of patients taking DMARDs for rheumatology related conditions.
General guidance on management of rheumatology patients during COVID-19 is available from the British Society for Rheumatology.
This page gives advice on drug monitoring in primary care during COVID-19 for ciclosporin when used as a DMARD in stable patients (stable patients are defined as those who have been on current treatment for >12 months and at a stable dose for >6 weeks)
Advice on drug monitoring for other medicines during COVID-19 is here
For ciclosporin, the usual monitoring recommendation is:
- 4 weekly monitoring of FBC, calculated GFR, CrCl, ALT and/or AST, albumin, BP and glucose
- Depending on local policy, people who have been stable for 12 months may be considered for reduced monitoring frequency on an individual basis
- More frequent monitoring may be appropriate in patients at higher risk of toxicity
During the Covid-19 pandemic, the recommendation to reduce attendances is:
- For those on 4 weekly monitoring, consider extending the monitoring interval to between 6 to 8 weeks with specialist advice
- For those who receive monitoring less frequently, seek specialist advice for extensions to monitoring during the COVID-19 pandemic
- For those who receive monitoring more frequently due to being at higher risk of toxicity, seek specialist advice for extensions to monitoring during the COVID-19 pandemic
For patients with symptoms of COVID-19, recommendations are:
- Consider stopping medication (see “Should patients cease their medication as a precaution?” advice from BSR) and seek specialist advice on when to re-start
- Undertake additional blood tests after self-isolation and within two weeks of re-starting medication
- If results okay—revert to monitoring at extended interval; if abnormal—seek specialist advice
- Refer patients to advice from Versus Arthritis
This page was developed in conjunction with Kalveer Flora, Chair, Rheumatology Pharmacists UK (RPUK); Lead Pharmacist, Specialised Rheumatology CRG for NHS England. We are hugely grateful for her input.
This advice has been developed quickly in response to the COVID-19 pandemic; if you spot anything that’s wrong report a concern to us.