Adherence to methotrexate in juvenile idiopathic arthritis

Pelajo, Christina F.; Sgarlat, Caitlin M.; Lopez-Benitez, Jorge M.; Oliveira, Sheila Knupp Feitosa de; Rodrigues, M; Sztajnbok, Flávio; Diniz, Christianne Costa; Miller, Laurie C.

doi:10.1007/s00296-010-1774-x

Cited by 35 publications

(55 citation statements)

References 14 publications

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“…Em nosso estudo, a taxa de adesão ao tratamento medicamentoso foi de 79,7%, e de uso de órteses foi de 52,6%, consistentes com a literatura 2,4,6,7,11,13,14 .…”

Section: Discussionunclassified

“…Com relação à terapêutica, o termo "boa adesão" é utilizado quando há o uso regular de mais de 80% dos medicamentos e de outras modalidades de tratamento prescritas [2][3][4][5][6] .…”

Section: Introductionunclassified

“…Sabemos que uma má adesão ao tratamento contribui para o aumento da sintomatologia e de hospitalizações desnecessárias, causando danos muitas vezes irreversíveis 1,[6][7][8][9][10][11] . É caracterizada como intencional quando o paciente decide não seguir as orientações por estar assintomático, por não compreender a necessidade do tratamento ou porque o uso das medicações interfere em sua qualidade de vida.…”

Section: Introductionunclassified

“…O interesse na avaliação da adesão de crianças e adolescentes com doenças crônicas tem aumentado nas últimas décadas, e os estudos que avaliam adesão em doenças reumáticas, em sua maioria, incluem apenas pacientes com artrite idiopática juvenil (AIJ) 3,4,6,7,9,[11][12][13][14] . As taxas de adesão à medicação em doenças reumáticas crônicas em crianças e adolescentes variam de 38 a 96% 2,4,6,7,11,[13][14][15] , sendo menores em adolescentes (50-55%) 2,15 .…”

Section: Introductionunclassified

“…As taxas de adesão à medicação em doenças reumáticas crônicas em crianças e adolescentes variam de 38 a 96% 2,4,6,7,11,[13][14][15] , sendo menores em adolescentes (50-55%) 2,15 . Em relação ao tratamento não medicamentoso, a adesão varia de 40 a 86% para exercícios 2,6,11,13,14 e cerca de 50% para uso de órteses 2 .…”

Section: Introductionunclassified

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Factors associated with adherence to treatment in children and adolescents with chronic rheumatic diseases

Bugni¹,

Ozaki²,

Okamoto³

et al. 2012

J Pediatr (Rio J)

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Objective: There are several factors that contribute to poor adherence to treatment in children and adolescents with chronic rheumatic diseases, worsening their quality of life and prognosis. Our aim was to assess the rates of adherence to treatment and to identify the socioeconomic and clinical factors associated. Methods:The sample included 99 patients with juvenile idiopathic arthritis, systemic erythematosus lupus, dermatomyositis or juvenile scleroderma. All patients were followed at the outpatient pediatric rheumatology for a minimum period of 6 months. To assess adherence, a questionnaire was administered to the providers, which included three blocks: 1) demographic, clinical and laboratory data; 2) medication adherence; and 3) attending follow-up appointments, examinations and use of orthoses. A value lower than or equal to 80% of the prescribed was considered poor adherence.Results: A total of 53% of patients showed good overall adherence, observed when the caregiver lived in a stable union marital status (p = 0.006); 20 patients (20.2%) presented poor medication adherence, related to the use of three or more medications daily (p = 0.047). The causes of poor adherence were forgetfulness, refusal, incorrect dose or lack of medication, personal problems, and financial difficulties. Conclusions:We observed good overall treatment adherence in patients whose providers lived in stable union and poor adherence to medication in patients who used more than three types of medication daily. There was no association between the adherence rates and sex, age, time since diagnosis and disease activity. J Pediatr (Rio J). 2012;88(6):483-8:Patient adherence, therapy, chronic disease, pediatrics, rheumatology. ResumoObjetivo: São vários os fatores que contribuem para a má adesão ao tratamento de crianças e adolescentes com doenças reumáticas crônicas, gerando piora da qualidade de vida e do prognóstico. Nosso objetivo foi avaliar as taxas de adesão ao tratamento e identificar os fatores socioeconômicos e clínicos associados. Métodos:Foram incluídos 99 pacientes com artrite idiopática juvenil, lúpus eritematoso sistêmico, dermatomiosite ou esclerodermia juvenil. Todos os pacientes eram acompanhados no ambulatório de reumatologia pediátrica por um período mínimo de 6 meses. Para avaliação da adesão, foi aplicado aos cuidadores um questionário composto por três blocos: 1) dados demográficos, clínicos e laboratoriais; 2) adesão ao tratamento medicamentoso; e 3) comparecimento às consultas, realização de exames e utilização de órteses. Foi considerada má adesão, quando realizado valor menor ou igual a 80% do prescrito.Resultados: Um total de 53% dos pacientes apresentou boa adesão ao tratamento global, observada quando o cuidador possuía união estável (p = 0,006); 20 pacientes (20,2%) apresentaram má adesão ao tratamento medicamentoso, relacionada à utilização de mais que três medicamentos diários (p = 0,047). As causas de má adesão ao tratamento foram esquecimento, recusa, dose incorreta ou falta de medicamento, prob...

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“…Em nosso estudo, a taxa de adesão ao tratamento medicamentoso foi de 79,7%, e de uso de órteses foi de 52,6%, consistentes com a literatura 2,4,6,7,11,13,14 .…”

Section: Discussionunclassified

Section: Introductionunclassified

See 3 more Smart Citations

Factors associated with adherence to treatment in children and adolescents with chronic rheumatic diseases

Bugni¹,

Ozaki²,

Okamoto³

et al. 2012

J Pediatr (Rio J)

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Treatment Satisfaction With and Adherence to Disease‐Modifying Antirheumatic Drugs in Adult Patients With Juvenile Idiopathic Arthritis

Tollisen

Flatø

Selvaag

et al. 2021

Arthritis Care & Research

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Objective To examine medication satisfaction and adherence and their relationships to disease variables and health‐related quality of life (HRQoL) in adults with juvenile idiopathic arthritis (JIA). Methods Patients (n = 96, mean age 25 years, 67% female) completed questionnaires about their health status 19 years after disease onset. Patients receiving biologic disease‐modifying antirheumatic drugs (bDMARDs) or methotrexate (MTX) were assessed with the 8‐item Morisky Medication Adherence Scale (MMAS‐8) and the Treatment Satisfaction Questionnaire for Medication (TSQM), including dimensions of effectiveness, side effects, convenience, and global satisfaction. Results DMARDs were received by 52 patients (54%) (mean age 25 years, 75% female), of which 28 received MTX and 37 received bDMARDs. Patients receiving combination therapy of MTX and bDMARDs (n = 15) reported higher satisfaction with bDMARDs than MTX in the dimensions of side effects and global satisfaction (mean ± SD 92.9 ± 15.5 versus 56.2 ± 30.9, and mean ± SD 67.6 ± 19.8 versus 47.1 ± 21.7; P < 0.001 and P = 0.016, respectively). Patients receiving either bDMARDs (n = 22) or MTX (n = 13) reported higher satisfaction with bDMARDs than MTX for the dimensions of effectiveness and global satisfaction (mean ± SD 78.7 ± 15.4 versus 60.2 ± 19.9, and mean ± SD 73.6 ± 17.7 versus 52.3 ± 23.9; P = 0.004 and P = 0.005, respectively). Nearly one‐half of patients (46%) reported low adherence (MMAS‐8 score <6) and 25% high adherence (MMAS‐8 score = 8). Higher levels of pain, psychological distress, more active joints, and current MTX use were the strongest correlates of lower medication satisfaction. Perceived medication effectiveness and global satisfaction correlated positively with physical and mental HRQoL. Conclusion Patients with JIA were more satisfied with bDMARDs than MTX, and 46% reported low adherence. Higher medication satisfaction was associated with better HRQoL.

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Assessing Methotrexate Adherence in Juvenile Idiopathic Arthritis Using Electronic Health Record–Linked Pharmacy Dispensing Data

Abel,

Anderson,

Kallan

et al. 2024

Arthritis Care & Research

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ObjectiveWe linked pharmacy dispensing data to clinical data in the electronic health record (EHR) to 1) identify characteristics associated with adherence to methotrexate (MTX) and 2) determine the association between adherence and disease activity in patients with JIA.MethodsWe conducted a single‐center retrospective cohort study of incident MTX users with JIA treated between 1/2016 and 9/2023 for ≥12 months. Using pharmacy dispensing data, complemented by EHR data, we estimated adherence using medication possession ratios (MPRs) over the first 365‐days of treatment. We used Fisher's exact and Wilcoxon rank‐sum tests to compare patient characteristics between adherent (MPR≥80%) and nonadherent (MPR<80%) groups and multivariable linear regression to investigate associations between MPR and active joint count.ResultsAmong 224 patients, 81 (36.2%) were classified as nonadherent. In bivariate analysis, patients of younger age, Black race, and from areas with lower child opportunity index (COI) were more likely to be classified as nonadherent. In multivariable analysis, active joint count changed from baseline to 12‐month follow‐up by ‐0.38 joints in the adherent compared to nonadherent group (95% CI ‐0.74,‐0.01) and by ‐1.18 joints in patients with polyarticular course (95% CI ‐2.23,‐0.13).ConclusionLinking dispense data to clinical EHR data offers a novel, objective method for evaluating adherence to chronic medications. We identified demographic and area‐level determinants of adherence, along with small but statistically significant differences in JIA disease activity measures by adherence status. Future work is needed to evaluate adherence as a potential mediator of known outcome disparities for socially disadvantaged populations.

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Adherence to methotrexate in juvenile idiopathic arthritis

Cited by 35 publications

References 14 publications

Factors associated with adherence to treatment in children and adolescents with chronic rheumatic diseases

Factors associated with adherence to treatment in children and adolescents with chronic rheumatic diseases

Treatment Satisfaction With and Adherence to Disease‐Modifying Antirheumatic Drugs in Adult Patients With Juvenile Idiopathic Arthritis

Assessing Methotrexate Adherence in Juvenile Idiopathic Arthritis Using Electronic Health Record–Linked Pharmacy Dispensing Data

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