Medication adherence and persistence in patients with autoimmune rheumatic diseases: a narrative review

Abstract

BackgroundSeveral drugs are available for the treatment of autoimmune rheumatic diseases; however, their effectiveness may be negatively influenced by inappropriate adherence. Low adherence and persistence rates have a significant impact on patient quality of life and are associated with health-related expenses.PurposeTo provide an up-to-date narrative review on treatment adherence and persistence rates, and discuss the factors that influence them, in patients with autoimmune rheumatic diseases.Materials and methodsWe searched the PubMed database for studies among patients with a diagnosis of rheumatoid arthritis (RA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), or psoriatic arthritis (PsA), published from January 2015 to February 2017. Only studies with a well-defined measurement of adherence/persistence and those that carried out an evaluation of the influencing factors were included.ResultsFifteen relevant studies that evaluated adherence and/or persistence were included. Adherence rates varied between 9.3% and 94%, and persistence rates between 23% and 80%. Most of the studies used one method to evaluate adherence or persistence (different questionnaire scores, proportion of days covered, and mean treatment duration). A high concordance was found between the adherence measurements of the Medication Event Monitoring System and Visual Analog Scale. Factors of economic, demographic, and clinical nature were only moderately linked to treatment adherence or persistence. However, patient-related factors – such as positive and increased beliefs in medication necessity, strong views of the chronic nature of the diseases, and increased knowledge of the disease – were related to better treatment adherence.ConclusionOwing to the heterogeneity of the study results, we consider that the use of more than one method to assess adherence/persistence should yield more comprehensive and accurate data about patient adherence behavior. Patient-related factors should be included and analyzed more often in adherence studies as the former may be modified to improve patient adherence.

Personal Health Perceptions as Predictors to Medication Adherence in a Prospective Cohort Study Among Patients with Multiple Sclerosis

“…Adherence to DMTs in this sample of PwMS, assessed by the combination of measures, medication claims and patients' reports (24), fell within the range reported in previous studies on medication adherence (2,21). The innovative nding of the present study is that adherence and persistence were consistently associated prospectively with patient-related factors, speci cally perceptions of medication -beliefs on the harm medication cause, their over-use and general concern.…”

“…The lack of association between background characteristics and adherence is different from some previous studies (17,18,35) yet similar to other (36). Indeed, a review on adherence in autoimmune conditions also concluded that economic, demographic, and clinical characteristics were only moderately linked to adherence or persistence (21). The ndings on the prospective association of beliefs about medication with adherence and persistence in medication taking is congruent with previous work in other conditions (37)(38)(39).…”

“…Hence, different measures (e.g., patients' reports, medication possession ration (MPR) and electronic monitoring devices (EMD)) are regarded as measuring different phenomenon, each with shared and unique variability related to clinical outcomes (19,20). Most studies, though, rely on a single method to evaluate adherence (21,22).…”

Association of Self-Reported Medication Adherence with Potentially Inappropriate Medications in Elderly Patients: A Cross-Sectional Pilot Study

“…In our hospital, since 1 September 2019, pharmacists have measured the VAS score of hospitalized patients at admission as routine work and, as a result, have provided better medication counseling to these patients than before. The VAS is used to assess medication adherence and shows high median or mean scores in a variety of populations: patients taking antidiabetes (median, 95.9%) and lipid-modifying (median, 95.2%) drugs [48]; hypertension/type 2 diabetes mellitus/dyslipidemia patients (mean, 91.3%) [51]; patients taking at least one hypertensive medication (median, 100%) [56]; IBD, including ulcerative colitis or Crohn's disease, patients (median, 91-100%) [50,54,57,58]; rheumatoid arthritis patients taking methotrexate (median, 94%) [59]; patients taking warfarin (mean, 92.2-96.6%) [49,60]; patients admitted to the psychiatric ward (mean, 86%) [61]; glaucoma patients (median, 95.0%) [62]; postmenopausal women with hormone receptor-positive breast cancer taking aromatase inhibitors (median, 100%) [63]; human immunodeficiency virus patients undergoing antiretroviral therapy (94-100%) [53,64]. Our median VAS score of 98% was high, similar to previous studies, probably because the study participants were self-administering elderly patients who were highly motivated to take their medications, leading to a high VAS score.…”

Patient behavior: an extensive review

“…As reported by the WHO, patient adherence to long-term therapies is alarmingly low in both developed and developing countries. 63 Nearly 50% of antibiotics are purchased and consumed without any medical supervision in most parts of the world. 64 Evil spirits are blamed for epilepsy in most part of the world.…”