A Targeted Literature Review Examining Biologic Therapy Compliance and Persistence in Chronic Inflammatory Diseases to Identify the Associated Unmet Needs, Driving Factors, and Consequences

Abstract

Chronic inflammatory diseases (CIDs) represent a substantial clinical and economic burden to patients, providers, payers and society overall. Biologics, such as tumor necrosis factor inhibitors (TNFi), have emerged as effective treatment options for patients with CIDs. However, the therapeutic potential of biologics is not always achieved in clinical practice, with results from studies examining the use of biologics in real-world settings suggesting lower levels of treatment effectiveness compared with clinical trial results. Using a targeted approach, this literature review demonstrates that compliance and persistence with biologic therapy is suboptimal and that this has implications for both clinical outcomes and treatment costs. The review identified a variety of predictors of treatment compliance and persistence, including increased age, female gender, presence of comorbidities, increased disease activity, longer disease duration, smoking, increased body mass index, higher biologic treatment dose, higher treatment cost and lower health-related quality-of-life scores. Patients often cited factors associated with medication delivery as a reason for non-compliance and non-persistence, and device-related improvements to treatment delivery were associated with higher rates of compliance and persistence. The articles identified in this review provide insights that have the potential to help guide the development of new solutions to improve disease management and optimize treatment regimens. This has the potential to benefit patients’ health by improving clinical outcomes and to reduce the burden to society by limiting the economic impact of patients’ disease.FundingUCB Pharma.Electronic supplementary materialThe online version of this article (10.1007/s12325-018-0759-0) contains supplementary material, which is available to authorized users.

A pilot study examining patient preference and satisfaction for ava®, a reusable electronic injection device to administer certolizumab pegol

“…Increased patient satisfaction has previously been shown to increase patient adherence [23]. Adherence to anti-TNFs for the treatment of CIDs is known to be low (59% [95% confidence interval: 58-60%]) [13], which in turn can reduce disease control and long-term outcomes [10,14]. High patient satisfaction levels with the e-Device may lead to improved adherence and clinical outcomes.…”

“…Patients may encounter challenges when self-injecting anti-TNFs [10,11]. These can include patient needle phobia, a lack of confidence in their own ability to safely and effectively administer injections and remembering the dates of their selfinjections [10][11][12]. As a result, adherence to anti-TNF treatment regimens is often suboptimal, negatively impacting patient outcomes and disease control [13][14][15].…”

“…Many patients with chronic inflammatory diseases (CIDs) are dependent on lifelong treatment to suppress joint damage and to avoid functional impairment. Tailoring self-injection devices to individual patient preference may improve patients' adoption of the device and, consequently, medication adherence [10,16,17]. Additionally, introducing more advanced technologies in the management of CIDs provides a unique value proposition as this approach may advance patient engagement and empowerment [18].…”

Patient‐reported reasons for and predictors of noncompliance with compression stockings in a randomized trial of stockings to prevent postthrombotic syndrome

“…7 The authors did not speculate as to the reasons for sex differences in ECS compliance. Cigarette smoking has been found to be a predictor of noncompliance with prescribed therapy across several fields of research, [8][9][10][11][12][13][14][15][16] and smoking cessation has been reported to be predictive of increased adherence to therapy. 17 To our knowledge, cigarette smoking has not previously been reported as a predictor of noncompliance with compression stocking use.…”

A multicenter, open-label study to evaluate the safe and effective use of a new electromechanical auto-injection device for self-injection of certolizumab pegol

“…Self-injection can be beneficial to both patients and caregivers, increasing flexibility and patient independence, reducing caregiver burden and reducing costs for both the patient and the healthcare system [5][6][7][8]. There are a number of barriers to patients successfully and safely selfinjecting anti-TNFs [2,5,6,9]; these include patients' needle phobia, lack of confidence in their ability to self-inject and forgetting to administer medicine [10,11]. These factors can contribute to sub-optimal levels of adherence to anti-TNF drug regimens, which has the potential to negatively impact patient outcomes [12,13].…”