Determinants of methotrexate adherence in rheumatoid arthritis patients

Abstract

In rheumatoid arthritis (RA) patients, weekly intake of methotrexate (MTX) is the basic drug treatment. This observational study aims to investigate how many RA patients are adherent in terms of MTX intake and to identify determinants of non-adherence. Intake of MTX (orally or via injection) was recorded in 129 RA patients with an electronic monitoring system (MEMS ® ) during 16 weeks. In addition, two adherence questionnaires, the Medication Adherence Report Scale (MARS-5) and the Compliance-Questionnaire-Rheumatology (CQR) as well as a visual analogue scale (VAS) measuring MTX adherence, were administered to these patients. As possible determinants of adherence, data on demographics, disease and treatment characteristics, depression, illness cognitions, motivation, and social support were collected. Of all participants, 58 % were fully adherent and 75 % skipped at most one dose during 16 weeks. A better mental health status and suffering from comorbidities had a positive effect on adherence, while living alone had a negative effect. These three predictors explained 30 % of the variance in MTX adherence. Of the three self-report medication adherence measures, the VAS correlated the highest with the results of the electronic monitoring system (r = 0.552, p = 0.01). A relatively high adherence rate was observed in RA patients treated with MTX. The determinants identified by this study could be used to screen patients at risk for non-adherence. A simple VAS scale seems to be an acceptable way for a preliminary screening of MTX adherence.

Adherence and Persistence with Methotrexate in Rheumatoid Arthritis: A Systematic Review

“…In the largest study of 129 patients receiving MTX, 58% were completely adherent and 91% were at least 80% adherent over the 16-week study period 26 . In another study of 23 patients taking MTX for the first time, the mean percentage of prescribed doses taken was 107% over 6 months (overuse) 19 .…”

“…For each study, data were extracted and quality was assessed. Results are summarized in Table 1 9,11,12,19,20,21,22,23,24,25,26,27 , Table 2, Table 3 [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47]48,49,50,51,52,53,54,55,56 , and Table 4, as well as Supplementary Table 2 and Supplementary Table 3 (available online at jrheum.org). MTX adherence.…”

“…MTX adherence. Twelve studies were identified that evaluated MTX adherence in patients with RA (Table 1) 9,11,12,19,20,21,22,23,24,25,26,27 . Most patients were enrolled in rheumatology outpatient clinics and were receiving MTX for the first time (Supplementary Table 2, available online at jrheum.org).…”

“…Adherence was evaluated using a Medication Event Monitoring System (MEMS; electronic chip that records medicine bottle opening) in 4 studies 12,19,25,26 . In the largest study of 129 patients receiving MTX, 58% were completely adherent and 91% were at least 80% adherent over the 16-week study period 26 .…”

Prevalence and Associated Factors for Non-adherence in Patients with Rheumatoid Arthritis

“…Among the questionnaires, we selected more objective questions that asked the number of days the patient failed to take their medication, and defined non-adherence failure to take medication 6 days or more. Compared to previous studies, the adherence rate of 90.4% is quite high [9][10][11][12][13][14][15][16][17][18][20][21][22][23][24][25][26][27][28][29]. We assumed that this result was due to the characteristics of the patient cohort rather than our method of estimation.…”