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
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.
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