Treating rheumatoid arthritis to target: physician and patient adherence issues in contemporary rheumatoid arthritis therapy

Abstract

Development of the treat-to-target (T2T) strategy, the process whereby drug therapy is adjusted until the therapeutic goal is achieved, has revolutionized how rheumatoid arthritis (RA) patients are treated. With the advent of T2T, the management of RA is more effective than ever, with the possibility of remission and other favorable clinical and patient-reported outcomes. Effective implementation of a T2T strategy in routine clinical practice mainly depends on the long-term commitment of physician and patient to T2T treatment recommendations. However, as T2T is a complex process involving aggressive early management with several steps of therapy modifications requiring frequent close monitoring of disease activity and drug toxicities, it may be more liable to suboptimal adherence in real-life clinical practice. The aim of the review is to present key issues related to patient medication adherence and physician adherence to the current RA treatment recommendations and their importance in optimizing the outcome of treatment in RA treated according to T2T strategy.

Management of rheumatoid arthritis in Poland – where daily practice might not always meet evidence-based guidelines

“…Educational interventions have been demonstrated to reduce physician non-adherence [ 22 ]. In a review by Wabe et al , medication side effects, comorbidities and persisting disease were among the factors associated with physician nonadherence to T2T [ 23 ]. We provide evidence that comorbidities and contraindications to RA-dedicated drugs are among the most prevalent reasons for delayed DMARD treatment.…”

“…Estimates provided may be inconsistent with medical records [ 9 ]. Assessing adherence of physicians is difficult, and is directly incomparable between studies due to a lack of standardization in assessments [ 23 ]. The questionnaire we used was not designed to assess adherence alone, but was developed in the perspective of RA management according to guidelines.…”

An autumn tale: geriatric rheumatoid arthritis

“…Early diagnosis, early administration of disease-modifying antirheumatic drugs (DMARDs) and targeted strategies have been able to prevent radiological progression, reduce morbidity and mortality, and increase functional capacity. 44 The main goal of RA treatment is to control the disease. Treatment of EORA should not be so different from the treatment of YORA.…”

Precision Medicine With Leflunomide: Consideration of the DHODH Haplotype and Plasma Teriflunomide Concentration and Modification of Outcomes in Patients With Rheumatoid Arthritis

“…However, our study did have some weaknesses. The results of our study represent associations rather than causality; for example, adherence to leflunomide was not assessed, and there is a possibility of confounding, because adherence is a behavior that extends beyond taking tablets and could result in both higher plasma teriflunomide concentrations and improved disease control via improved self‐efficacy strategies and implementation of nonpharmacologic management strategies (28). Only 45% of participants were recruited at initiation of leflunomide, and thus the remaining 55% may have been enriched for responders to leflunomide when there was a substantial period since commencement of the drug.…”