Article Text

PDF
CP-104 Adherence to disease modifying antirheumatic drugs in patients with rheumatoid arthritis
  1. MM Alañón Pardo1,
  2. VL Areas del Águila1,
  3. JL Cuadra Díaz2,
  4. M Paulino Huertas2,
  5. A Ariza Hernández2,
  6. MD Mínguez Sánchez2,
  7. E Revuelta Evrard2,
  8. R Arenal López2,
  9. E Vila Torres1,
  10. C Encinas Barrios1
  1. 1Ciudad Real University General Hospital, Department of Pharmacy, Ciudad Real, Spain
  2. 2Ciudad Real University General Hospital, Department of Rheumatology, Ciudad Real, Spain

Abstract

Background A lack of adherence to disease modifying antirheumatic drugs (DMARDs) can increase inflammatory activity (IA) in patients with rheumatoid arthritis (RA).

Purpose To estimate adherence to subcutaneous biological (DMARD-b) and conventional (DMARD-c) DMARDs in RA patients. To evaluate IA as a function of DMARD adherence.

Material and methods Cross sectional study in pharmaceutical care outpatients with RA receiving DMARD-b at a 550 bed hospital in April 2015.

Study variables: age, sex, DMARDs, adherence and IA.

Adherence was evaluated by two indirect methods: (1) patient self-administered questionnaire (CQR5-Compliance Questionnaire Rheumatology); and (2) electronic dispensation records, calculating the ‘medication possession rate’ (MPR), defined as the number of days a medication was dispensed divided by the number of days of the treatment period during the previous 12 months.

‘Adherent’ patients were defined by MPR ≥80% and CQR5 classification of ‘high adherence’.

DAS28 was used to evaluate IA as in remission (DAS28 ≤2.6), low (DAS28 ≤3.2) or moderate (DAS28 >3.2). <DAS28 <5.1) >Data were obtained from: electronic clinical records, community pharmacy electronic prescription dispensing programmes (specialists and community physicians), outpatient dispensing records and pharmaceutical interview.

Statistical analysis: Pearson’s χ2 test was used to compare IA between adherence and non-adherence groups to combination therapy with DMARD-b and DMARD-c. </DAS28 <5.1) >.

Results The study included 55 patients (81.8% females, mean age 56 ± 14.0 yrs) treated with DMARD-b (50.9% etanercept, 30.9% adalimumab,12.7% certolizumab, 5.5% golimumab): 19 with monotherapy and 36 associated with DMARD-c (72.2% methotrexate,13.9% leflunomide,13.9% others).

81.8% of patients were adherent to DMARD-b (89.5% with monotherapy). Adherence was higher for adalimumab (82.4%) than for other DMARD-b.

In the combination therapy group, 58.3% were adherent to both (DMARD-b 77.7%, DMARD-c 72.2%). Adherence was higher to leflunomide (80.0%) than to methotrexate (69.2%).

Among the 17 adherent patients receiving DMARD-b monotherapy, IA was in remission in 35.3%, low in 17.6%, moderate in 35.3% and high in 11.8%. Among non-adherent patients, 1 was in remission and 1 had low IA.

Comparing the adherence and non-adherence groups receiving combination therapy, IA was in remission in 38.9% vs. 30.8% (p > 0.05), low in 22.2% vs. 30.8% (p > 0.05) and moderate in 38.9% vs. 38.4% (p > 0.05), respectively.

Conclusion Adherence to DMARD-b was high in RA patients. Adherence to the combination therapy was lower, being higher for DMARD-b than for DMARD-c. Non-adherence to this combination therapy does not appear to increase IA.

References and/or Acknowledgements

  1. Hughes. A 5 item version of the Compliance Questionnaire for Rheumatology (CQR5) successfully identifies low adherence to DMARDS. BMC Musculoskeletal Disorders 2013;14:286-94

References and/or AcknowledgementsNo conflict of interest.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.