PhD student Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK London, United Kingdom
Background: There have been concerns about the potential disruptions to prescribing for patients with chronic respiratory diseases like asthma during the COVID-19 pandemic. Leukotriene receptor antagonists (LTRAs) are a class of maintenance medications used in patients with mild to moderate chronic asthma. Little is known about whether LTRAs prescribing has changed during the pandemic.
Objectives: To investigate the impact of COVID-19 pandemic on LTRAs prescribing.
Methods: We obtained the nation-wide monthly data on prescribing activity and appointment activity in general practice in England from January 2018 to November 2022 from OpenPrescribing and National Health Service (NHS) England. We conducted an interrupted time-series analysis (ITS) to assess any immediate change and gradual change in monthly prescribing rate and absolute number of prescribed LTRAs. Interruptions were set at the months of March 2020, the start of the pandemic restrictions in the UK, and July 2021, when restrictions were lifted in England. Incidence rate ratios (IRRs) and 95% confidence intervals (CI) were estimated using negative binomial models, with adjustment for seasonal effects and autocorrelation.
Results: The start of the pandemic saw an immediate increase in the number of LTRAs items prescribed per 100 appointments (IRR 1.40, 95% CI 1.32–1.49). The prescribing rate then gradually declined during the pandemic (IRR 0.98, 95% CI 0.97–0.98) but remained higher than the expected trend until March 2021. The lifting of lockdown restrictions in July 2021 saw an immediate increase in the prescribing rate (IRR 1.06, 95% CI 1.00–1.13). The prescribing rate continued to increase gradually throughout the rest of the study period (IRR 1.02, 95% CI 1.01–1.03) and remained in line with the expected trend. Similarly, the absolute number of LTRAs prescribed increased at the start of the pandemic (IRR 1.05, 95% CI 1.02–1.09). The absolute number of items did not change significantly after the lifting of lockdown restrictions (IRR 1.02, 95% CI 0.99–1.06).
Conclusions: There was an immediate increase in the LTRAs prescribing at the start of the pandemic, which might suggest patients and clinicians attempted to ensure continuity of access to LTRAs in the face of the pandemic. The LTRAs prescribing rate then declined and fell back to the expected trend during the pandemic. The prescribing rate increased after the lockdown restrictions were lifted but remained within the expected trend. Further studies are warranted to examine the factors that may play a role in the changes in the prescribing of LTRA during and beyond the pandemic to inform care for patients with asthma.
