Effectiveness of electronic drug monitoring feedback to increase adherence in patients with RA initiating a biological DMARD: a randomised clinical trial

Abstract

ObjectiveMedication non-adherence in rheumatoid arthritis (RA) is associated with disease flares, increased disability and increased costs. This study assessed the effectiveness of electronic monitoring feedback (EMF) on medication adherence in patients with RA starting with or switching to a new biological disease-modifying antirheumatic drug (bDMARD).MethodsIn this randomised controlled trial, bDMARD starters were assigned to the intervention or control group and followed for 1 year. The intervention group received a needle container with a Medication Event Monitoring System (MEMS) cap registering patient’s adherence to injections. Scores were calculated every 3 months with MEMS and motivational interviewing feedback was given. The control group received usual care. Effectiveness of EMF on adherence was measured with the medication possession ratio (MPR).Results104 consecutive intervention patients were included and 102 controls. MPR was 0.95 (SD: 0.10) and 0.90 (0.16) after 12 months (B: 0.036, 95% CI: 0.001 to 0.007, p=0.045). bDMARD-naive patients receiving EMF achieved low disease activity (LDA) sooner compared with the control group, adjusted for baseline DAS (HR: 1.68, 95% CI: 1.00 to 2.81, p=0.050). Side effects and DAS28 were similar.ConclusionEMF increased adherence for patients with RA starting with or switching to a bDMARD. Especially bDMARD-naive patients achieved LDA sooner compared with the control group, which holds promise for the future.

What Do We Know about Medication Adherence Interventions in Inflammatory Bowel Disease, Multiple Sclerosis and Rheumatoid Arthritis? A Scoping Review of Randomised Controlled Trials

“…Also, unclear reporting of time points due to multiple anomalies). Hebing et al 52 2022, RA To assess effectiveness of electronic monitoring feedback ( EMF) on medication adherence in patients with RA starting with or switching to new biological disease modifying antirheumatic drugs ( bDMARDs). None stated Participants assigned to group and monitored for 12 months.…”

“…Post-intervention data [6 week] used instead) . -Baseline, 6 weeks (immediate post-intervention) and 12 weeks Medium 9) Hebing et al 52 2022; Netherlands Randomised: 206 Intervention 104 Control 102 Intervention 53.5 (±12.1) Contro l 51.2 (±13.6) Overall 52.4 ( not stated ) Intervention Male 31 (30%) Female 73 (70%) Control Male 28 (27%) Female 74 (73%) Overall Male 59 (28.6%) Female 147 (71.4%) RA Outpatient clinic RCT; unblinded -Completion: no 1° completion data (ITT used) -Baseline and every 3 months (12 months duration) High 10) Keefer at al 53 2012; USA Randomised: 30 Intervention 17 (16 1° Endpoint analysis) Control 13 (12 1° Endpoint analysis) Intervention 34.5 (29–39) Control 40.8 (31–49) (No SD stated, only range) Overall 37.7 (not stated) Overall Male 10 (30%) Female 18 (70%) (Not stated/arm, but overall values given). IBD Outpatient clinic Pilot RCT; unblinded -Completion: 28 (93.3%) (analysis type not stated) -Baseline and 8 weeks Medium 11) Landtblom et al 36 2019; Sweden Randomised: 93 Intervention 46 Control 47 Intervention 41 (±13.2) Control 38 (±10.9) Overall 39.5 (not stated) Intervention Male 14 (37%), Female 24 (63%) Control Male 15 (38%) Female 24 (62%) Overall Male 29 (31.2%) Female 48 (51.6%) MS Outpatient (multicentre) RCT; single-blinded (participants) -Completion: 53 (57%) (ITT and per protocol used) -Baseline, 6 and 12 months High …”

“…Eight studies showed no significant effect on medication adherence, 36,46,52,53,55,56,63,65 but two of these were pilot studies only. 52,55 These varied across length of intervention from 15 minutes 63 to 12 months 36,46,[64][65][66] and follow-up from 1 month 63 to 14 months. 56 Sample size and attrition rate, use of theory and approach were also variable amongst these interventions.…”

Big data analyses and individual health profiling in the arena of rheumatic and musculoskeletal diseases (RMDs)

“… 100 , 101 Some studies have already shown that telemedical appointments may replace certain types of physical visits (e.g. follow-up visits) leading to non-inferior outcomes 102 – 104 Ideally future hybrid management of care can be prepared with patients beforehand, using examples like guides for musculoskeletal examination for telemedicine. 105 All these advancements might need standard frameworks and regulations as well as manuals for rheumatology practitioners to act in a legal, best-practice, and financially reimbursed space.…”

The Patient Experience of Drug Side Effects in Rheumatoid Arthritis: Intriguing Data From an Exploratory Online Survey

“…1 They are also an important source of treatment nonadherence, with deleterious effects on disease outcomes. 2,3 Gaining insight into patients' experiences with medication side effects could help inform the development of new shared decision-making approaches to enhance treatment adherence and long-term disease and health outcomes.…”