Electronic Monitoring of Oral Therapies in Ethnically Diverse and Economically Disadvantaged Patients With Rheumatoid Arthritis: Consequences of Low Adherence

Abstract

Background To quantify adherence to oral therapies in ethnically diverse and economically disadvantaged patients with rheumatoid arthritis (RA) using electronic medication monitoring, and to evaluate the clinical consequences of low adherence. Methods 107 patients with RA enrolled in a 2-year prospective cohort study agreed to have their oral RA drug therapy intake electronically monitored, with the Medication Events Monitoring System (MEMS®). Adherence to disease-modifying antirheumatic drugs (DMARDs) and prednisone were determined as the percentage of days (or weeks for methotrexate) in which the patient took the correct dose as prescribed by the physician. Patient outcomes were assessed including the Modified Health Assessment Questionnaire (MHAQ), the Disease Activity Index 28 (DAS28), quality of life and radiological damage using Sharp-van der Heijde scores. Results Adherence to the treatment regimen as determined by percent of correct doses was 64% for DMARDs and 70% for prednisone. Patients who had better mental health were statistically more likely to be adherent. Only 23 (21%) of the patients had an average adherence to DMARDs ≥ 80%. These patients showed significantly better disease activity scores across 2 years of follow-up than those who were less adherent (DAS28 3.3±1.3 vs. 4.1±1.2, p<0.02). Radiological scores were also worse in non-adherent patients at baseline and 12 months. Conclusions Only one fifth of the RA patients had an overall adherence of at least 80%. Less than two thirds of the prescribed DMARD doses were correctly taken. Adherent patients had lower disease activity and radiological damage scores across the 2 years of follow-up.

Impact of prior biologic use on persistence of treatment in patients with psoriatic arthritis enrolled in the US Corrona registry

“…Based on results from a nationwide cohort of patients with PsA, slightly more than half (52%) of the patients included in this study were persistent with their TNFi therapy at 24 months Persistence is often associated with treatment efficacy [8][9][10][11][12][13][14]. The current study provides insight into the factors that influence persistence with a TNFi and how persistence differs based on prior exposure to biologics.…”

“…Treatment persistence and prior biologic use are well documented in patients with RA and psoriasis; however, less is known about persistence in patients with PsA [8][9][10][11][12][13][14]. PsA is manifested in a diverse range of symptoms, and symptom severity varies over time, which complicates treatment and may influence treatment persistence [15,16].…”

Determinants of methotrexate adherence in rheumatoid arthritis patients

“…The way medication adherence is measured may however be responsible for diversity in results [2]. Self-reported adherence mostly results in higher adherence rates than electronic monitoring, which was only used in two studies in RA patients [3,4].…”

Reply

“…We read with great interest the recent article by Waimann et al (1). Their study led to 2 major conclusions: 1) only one-fifth of patients with rheumatoid arthritis had an overall adherence to disease-modifying antirheumatic drugs (DMARDs) of at least 80%, and 2) nonadherent patients had higher disease activity across a 2-year followup period.…”