Impact of inadequate adherence on response to subcutaneously administered anti-tumour necrosis factor drugs: results from the Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate cohort

Abstract

Objective. Non-adherence to DMARDs is common, but little is known about adherence to biologic therapies and its relationship to treatment response. The purpose of this study was to investigate the association between self-reported non-adherence to s.c. anti-TNF therapy and response in individuals with RA.Methods. Participants about to start s.c. anti-TNF therapy were recruited to a large UK multicentre prospective observational cohort study. Demographic information and disease characteristics were assessed at baseline. Self-reported non-adherence, defined as whether the previous due dose of biologic therapy was reported as not taken on the day agreed with the health care professional, was recorded at 3 and 6 months following the start of therapy. The 28-joint DAS (DAS28) was recorded at baseline and following 3 and 6 months of therapy. Multivariate linear regression was used to examine these relationships.Results. Three hundred and ninety-two patients with a median disease duration of 7 years [interquartile range (IQR) 3–15] were recruited. Adherence data were available in 286 patients. Of these, 27% reported non-adherence to biologic therapy according to the defined criteria at least once within the first 6-month period. In multivariate linear regression analysis, older age, lower baseline DAS28 and ever non-adherence at either 3 or 6 months from baseline were significantly associated with a poorer DAS28 response at 6 months to anti-TNF therapy.Conclusion. Patients with RA who reported not taking their biologic on the day agreed with their health care professional showed poorer clinical outcomes than their counterparts, emphasizing the need to investigate causes of non-adherence to biologics.

Adherence to Anti–Tumor Necrosis Factor Therapy Administered Subcutaneously and Associated Factors in Patients With Rheumatoid Arthritis

“…33,35 More recently, Waimann et al 36 found that adherence to oral disease-modifying antirheumatic drugs and corticosteroid therapy in patients with RA was low, ranging from 58% to 71%, with only one fifth of patients showing greater than 80% adherence. Recently, Bluett et al 37 reported nonadherence with biological therapy in 57 (20%) of 286 patients. Also, it has been reported that 21% to 35% of patients who are administered anti-TNF therapy discontinue within their first year of treatment.…”

Differential Drug Survival of Biologic Therapies for the Treatment of Psoriasis: A Prospective Observational Cohort Study from the British Association of Dermatologists Biologic Interventions Register (BADBIR)

“…A study into self-reported adherence to self-injectable TNFIs in rheumatoid arthritis patients found that 27% of patients had not taken the drug on the scheduled date on at least one occasion in the first 6 months of therapy (Bluett et al, 2014). Crucially, this was associated with a lower measured response following 6 months of therapy, suggesting that non-adherence may play a role in the loss of effectiveness of biologic therapies.…”

Impact of Temperature on Injection-Related Pain Caused by Subcutaneous Administration of Ustekinumab: A Three-arm Crossover Open-label Randomized Controlled Trial

“…However, the long-term efficacy of these medications is directly dependent upon the degree of patient compliance and medication adherence. 1 While usually welltolerated, most biologic agents are injectable drugs. The subcutaneous injections can be painful, and fear of the needle can be a real issue, and may even prevent some patients from undergoing treatment with a biologic agent.…”