BackgroundLack of adherence to medication in rheumatoid arthritis (RA) can worsen disease activity, but data on adherence to biological drugs is scarce.ObjectivesTo evaluate RA patients adherence to the subcutaneous (SC) biological treatment prescribed by the physician during the first year of treatment.MethodsRetrospective study in RA patients ≥18 years-old from 42 Spanish hospitals, which had been prescribed a SC biological drug 12 to 18 months prior to the study visit. Data were collected from patients' clinical records and hospital pharmacy drug-dispensing logs. Adherence was evaluated through the Medication Possession Ratio (MPR) (actual number of days covered by the taken medication/theoretical number of days covered by the prescribed medication). The number of days theoretically covered was calculated considering the interval of administration of the prescribed biological drug, if induction dose was prescribed, and if there were suspension periods or changes in the dose. The actual number of days covered was calculated with the number of vials that the patient had taken from the hospital pharmacy during the study period. Non-adherence was diagnosed if MPR was ≤80%.Results364 patients were included (age 54.9 years [12.5]; 77.5% women, median RA duration 7.8 years). The initial interval of administration of the biological drug was weekly (44.2%), biweekly (39.1%) and monthly (17.3%); the median duration of the period studied was 14.8 months. For the primary analysis, 363 patients were valid, of which 52 patients were non-adherent (MPR ≤80%) to the prescribed schedule (14.3%; 95% CI: 11.1–18.3). There were no differences in adherence by age ranges, gender or other socio-demographic factors, such as level of education, smoking habit or alcohol intake, employment status, comorbidities or polypharmacy (all, p= NS). Non-adherence was less frequent in patients with a monthly administration schedule (6.4%) than in patients with a weekly (17.4%, p=0.034) or biweekly administration (14.4%, p=0.102), and slightly more frequent in those receiving induction (21.6% vs 12.5% without induction, p=0.068). No differences were observed between patients who used syringes or pen devices, or in patients who had periods of treatment interruption.ConclusionsIn RA patients, 14.3% were non-adherent to the prescribed SC biological medication during the first year of treatment, with no differences related to socio-demographic variables. Adherence was higher in those patients with monthly subcutaneous administration.AcknowledgementThe ARCO study was funded by Merck Sharp & Dohme of Spain.Disclosure of InterestNone declared

ObjectiveThe aim of this study was to explore perceptions of patients with rheumatic diseases treated with subcutaneous (SC) biological drugs on the impact on daily life and satisfaction with current therapy, including preferred attributes.MethodsA survey was developed ad hoc by four rheumatologists and three patients, including Likert questions on the impact of disease and treatment on daily life and preferred attributes of treatment. Rheumatologists from 50 participating centers were instructed to handout the survey to 20 consecutive patients with rheumatoid arthritis (RA), axial spondyloarthritis (ax-SpA), or psoriatic arthritis (PsA) receiving SC biological drugs. Patients responded to the survey at home and sent it to a central facility by prepaid mail.ResultsA total of 592 patients returned the survey (response rate: 59.2%), 51.4% of whom had RA, 23.8% had ax-SpA, and 19.6% had PsA. Patients reported moderate-to-severe impact of their disease on their quality of life (QoL) (51.9%), work/daily activities (49.2%), emotional well-being (41.0%), personal relationships (26.0%), and close relatives’ life (32.3%); 30%–50% patients reported seldom/never being inquired about these aspects by their rheumatologists. Treatment attributes ranked as most important were the normalization of QoL (43.6%) and the relief from symptoms (35.2%). The satisfaction with their current antirheumatic therapy was high (>80% were “satisfied” or “very satisfied”), despite moderate/severe impact of disease.ConclusionPatients with rheumatic diseases on SC biological therapy perceive a high disease impact on different aspects of daily life, despite being highly satisfied with their treatment; the perception is that physicians do not frequently address personal problems. Normalization of QoL is the most important attribute of therapies to patients.

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This observational, longitudinal retrospective, noncomparative study was designed to assess the persistence and effectiveness of golimumab as a second anti-tumor necrosis factor (TNF) drug in patients with spondyloarthritis requiring discontinuation from a first anti-TNF drug. Data were collected retrospectively for all patients with axial spondyloarthritis or psoriatic arthritis from 20 rheumatology clinics in Spain who started golimumab as a second anti-TNF drug between January 2013 and December 2015. Golimumab persistence was assessed with Kaplan-Meier survival analysis, and associated factors were assessed with Cox regression analysis. 210 patients started golimumab as a second anti-TNF drug: 131 with axial spondyloarthritis and 79 with psoriatic arthritis. In axial spondyloarthritis patients, the mean (standard deviation) Bath Ankylosing Spondylitis Disease Activity Index score at baseline was 5.5 (2.1), decreasing to 3.9 (2.0) at month 3 and 3.5 (2.0) at year 1, and remaining stable thereafter. In psoriatic arthritis patients, mean (standard deviation) baseline Disease Activity Score was 4.0 (1.3), reducing to 2.5 (1.2) at month 3 and to 2.2 (1.3) at year 1. Corresponding improvements were recorded from baseline in C-reactive protein levels and erythrocyte sedimentation rates. The probability of persistence of treatment with golimumab was 80% at year 1, 70% at year 2 and 65% at years 3 and year 4, and was similar in those who had stopped the first anti-TNF due to loss of efficacy or other reasons. Cox regression analysis showed that the probability of survival with golimumab was higher in patients with higher erythrocyte sedimentation rate, in patients with axial spondyloarthritis than with psoriatic arthritis, and in those who had discontinued adalimumab as first anti-TNF. Seventy-two patients (34.3%) discontinued golimumab during follow-up, 50 of them due to lack of efficacy. In patients with spondyloarthritis requiring discontinuation from a first anti-TNF drug, treatment with golimumab was effective and showed a high probability of persistence up to 4 years of treatment.