A Systematic Review of Factors Associated with Non-Adherence to Treatment for Immune-Mediated Inflammatory Diseases

Abstract

BackgroundNon-adherence impacts negatively on patient health outcomes and has associated economic costs. Understanding drivers of treatment adherence in immune-mediated inflammatory diseases is key for the development of effective strategies to tackle non-adherence.ObjectiveTo identify factors associated with treatment non-adherence across diseases in three clinical areas: rheumatology, gastroenterology, and dermatology.DesignSystematic review.Data SourcesArticles published in PubMed, Science Direct, PsychINFO and the Cochrane Library from January 1, 1980 to February 14, 2014.Study SelectionStudies were eligible if they included patients with a diagnosis of rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease, or psoriasis and included statistics to examine associations of factors with non-adherence.Data ExtractionData were extracted by the first reviewer using a standardized 23-item form and verified by a second/third reviewer. Quality assessment was carried out for each study using a 16-item quality checklist.Results73 studies were identified for inclusion in the review. Demographic or clinical factors were not consistently associated with non-adherence. Limited evidence was found for an association between non-adherence and treatment factors such as dosing frequency. Consistent associations with adherence were found for psychosocial factors, with the strongest evidence for the impact of the healthcare professional–patient relationship, perceptions of treatment concerns and depression, lower treatment self-efficacy and necessity beliefs, and practical barriers to treatment.ConclusionsWhile examined in only a minority of studies, the strongest evidence found for non-adherence were psychosocial factors. Interventions designed to address these factors may be most effective in tackling treatment non-adherence.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-015-0256-7) contains supplementary material, which is available to authorized users.

Treatment patterns, unmet need, and impact on patient-reported outcomes of psoriatic arthritis in the United States and Europe

“…This may be a reflection of access to advanced therapies in the EU5, with public insurance coverage being more prominent compared with the US healthcare systems. A recent systematic review of medication adherence in patients with a range of conditions, including PsA, identified varying levels of non-adherence, which can impact negatively on health outcomes and have associated economic costs [49]. In the systematic review, psychosocial factors, such as perceived treatment efficacy and safety, emotional well-being, HCP–patient relationship, and practical barriers, were shown to be key factors in determining patient adherence to treatment, while demographic and clinical factors showed less of an association with adherence [49].…”

Next generation of small molecules in inflammatory bowel disease

“…This is why most SMDs must be taken daily or twice daily. However, long-term adherence to treatment with oral drugs is often poor in clinical practice and the best way to improve this is still being debated 41 42. Nevertheless, adherence to intravenously or subcutaneously administered anti-TNF therapeutics in IBD is not optimal either 43…”

“…First, long-term adherence to other oral drugs used in IBD (such as azathioprine and aminosalicylates) is poor 42. Second, the SMDs' positioning will remain a matter of debate until head-to-head trials against monoclonal antibodies or between SMDs are performed.…”

Topical medication utilization and health resources consumption in adult patients affected by psoriasis: findings from the analysis of administrative databases of local health units

“…Considering that patients with chronic disorders are less likely to be compliant with treatment regimen compared with those with acute conditions;31 non-adherence is one of the key factors in the real-life effectiveness of treatments for chronic disorders, such as psoriasis 32. Medication non-adherence can have harmful effects on optimal management of psoriasis: non-adherence leads to poor outcomes, more hospitalizations, and significantly higher health care costs 30,33–35. Our findings are consistent with previous investigations36,37 that demonstrated a suboptimal adherence to topical treatments, likely reflecting the intermittent use of most topical products.…”