Treatment adherence and disease burden of individuals with rheumatic diseases admitted as outpatients to a large rheumatology center in Shanghai, China

Abstract

PurposeThe purpose of this study was to determine treatment adherence and disease burden, analyze detailed medication problems experienced by patients, and identify factors associated with adherence in patients with rheumatic diseases in China.Patients and methodsPatients with confirmed diagnoses of ankylosing spondylitis (AS), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE) were recruited, regardless of demographics, disease severity, and treatment characteristics. Adherence was assessed using the Compliance Questionnaire for Rheumatology and interview-based self-reports. A backwards-stepwise multivariate regression analysis was used to identify factors associated with adherence.ResultsWe collected data on 252 patients who had a rheumatic disease and visited our outpatient clinic in January or February of 2017. There were 121 patients with SLE, 70 with RA, and 61 with AS. The overall adherence rate was 41.7%, with 48.7% for SLE patients, 38.6% for RA patients, and 31.1% for AS patients. The overall EuroQol (EQ)-index was 0.761; AS patients had the best EQ-index (0.792), followed by those with SLE (0.780) and RA (0.700). SLE patients also had greater annual direct costs (US$5,103.58) than RA or AS patients.ConclusionOverall, 41.7% of our rheumatic disease patients were adherent to treatment, lower than in many other parts of the world. This indicates that it is important to identify methods that improve adherence in this population. It is particularly important to improve the health status and reduce the disease burden of patients with SLE, the most common of the three rheumatic diseases we analyzed. Our results suggest that reminder tools may improve adherence. Further prospective research is needed to confirm whether reminder tools and other measures can improve patient compliance.

Investigating the safety and compliance of using csDMARDs in rheumatoid arthritis treatment through face-to-face interviews: a cross-sectional study in China

“…AE adverse event, csDMARD conventional synthetic disease-modifying antirheumatic drugs, HCQ hydroxychloroquine, LEF leflunomide, MTX methotrexate, SASP salazosulfapyridine a Rheumatologists were asked to estimate whether each AE was common, and calculated the number and proportion of people who believed it was a common AE b Patients were asked to report the AEs they once experienced and calculated the number and proportion of each AE However, due to the paucity in the literature of similarly designed studies, AE occurrence cannot be directly compared. The non-compliance rate (40.8%) was within the range of those reported by other RA studies conducted in China (19.8-61.4%) [18,19]. Non-compliance would eventually worsen disease activity, which acts against the treat-to-target strategy.…”

<p>Methotrexate (MTX) Plus Hydroxychloroquine versus MTX Plus Leflunomide in Patients with MTX-Resistant Active Rheumatoid Arthritis: A 2-Year Cohort Study in Real World</p>

“…38 On the other hand, the classic triple therapy of MTX+SSZ+HCQ, which bore abundant evidence in terms of efficacy; 8 , 17 however, its compliance was problematic in Chinese patients according to our previous real-world data. 14 The main reason seemed to be that patients were reluctant to take an extra 4–8 SSZ tablets each day (with a therapeutic dose of 1–2 gram/day). MTX+LEF apparently provided an alternative option; and within the dose range the safety profile was good.…”

“…[10][11][12][13] Previous studies demonstrated that the global disease burden of RA ranked fifth in musculoskeletal diseases, and its average annual direct cost in China could reach $3,069. 14,15 The increasing disease burden in light of pharmacoeconomic analysis is at least partially relevant to the emerging targeted therapies. Therefore, in the real-world practice, to give the csDMARDs a "second chance" is always a serious consideration for both health providers and patients.…”

Lack of patient education is risk factor of disease flare in patients with systemic lupus erythematosus in China

“…Previous studies of patients with SLE, which had different populations and methodologies, reported that adherence ranged from 3 to 76%, 67% for glucocorticoids, 48.6%~ 93% for hydroxychloroquine, and 57% for other immunosuppressants [4–6]. Besides, the rate of treatment adherence in China was about 48.7% based on our previous study [7]. Moreover, chronic rheumatic conditions are inclined to result in substantial burdens such as economic burden for patients and their families.…”

“…In Europe, the per capita annual direct medical cost of patients with SLE reaches €4748 (US$5037.15), up to US$6269 [8–10] in the US. Surprisingly, the cost in our previous study of SLE population also reached $5103 in China [7], which is a huge expenditure for a developing country. The results of our previous study suggest that we have defects in the management of lupus patients, and we should take measures to improve their adherence and reduce the disease burden.…”