Medication adherence and persistence in patients with rheumatoid arthritis, psoriasis, and psoriatic arthritis: a systematic literature review

Abstract

PurposeProper adherence and persistence to medications are crucial for better quality of life and improved outcomes in rheumatoid arthritis (RA), psoriasis (PsO), and psoriatic arthritis (PsA). We systematically describe current adherence and persistence patterns for RA, PsO, and PsA, with a focus on biologics and identifying factors associated with adherence and persistence.Patients and methodsUsing various databases, a systematic literature review of US-based studies published from 2000 to 2015 on medication adherence and persistence to biologics and associated factors was conducted among patients with RA, PsO, and PsA.ResultsUsing the medication possession ratio or the percentage of days covered >80%, RA and PsO adherence rates for etanercept, adalimumab, and infliximab ranged from 16% to 73%, 21% to 70%, and 38% to 81%, respectively. Using the criteria of a ≥45-day gap, RA persistence rates for etanercept, adalimumab, and infliximab ranged from 46% to 89%, 42% to 94%, and 41% to 76%, respectively. In PsO, persistence rates for etanercept and adalimumab ranged from 34% to 50% and 50% to 62%, respectively. Similar persistence rates were observed in PsA. Experienced biologics users showed better adherence and persistence. Younger age, female gender, higher out-of-pocket costs, greater disease severity, and more comorbidities were associated with lower adherence and persistence rates. Qualitative surveys revealed that nonpersistence was partly due to perceived ineffectiveness and safety/tolerability concerns.ConclusionBiologic adherence and persistence rates in RA, PsO, and PsA in the United States were low, with significant opportunity for improvement. Various factors – including decrease in disease severity; reduction of comorbidities; lower out-of-pocket costs; refilling at specialty pharmacies; and awareness of drug effectiveness, safety, and tolerability – can inform targeted approaches to improve these rates.

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“…10 A systemic review showed that the median adherence rate for etanercept was 63% (range, 16-73%) in patients with rheumatoid arthritis. 11 Low adherence to therapeutic regimen has negative consequences and can lead to substantial costs, increased disease flares, disease progression, increased disability, additional medical therapy, and sometimes surgery. 12,13 Nonadherence can be intentional and nonintentional, and poor manual dexterity can impact the person's ability and skill at medicine-taking leading to unintentional nonadherence.…”

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“…Safety, pharmacodynamics and efficacy can only be adequately assessed and interpreted if patient data on treatment adherence are available. The impact of poor adherence varies across numerous chronic skin disorders . For instance, non‐adherence to topical regimens leads to increased scores on the six area, six sign atopic dermatitis (SASSAD) severity scale, indicating the disease severity in patients with atopic dermatitis .…”

“…The impact of poor adherence varies across numerous chronic skin disorders. 9,10 For instance, non-adherence to topical regimens leads to increased scores on the six area, six sign atopic dermatitis (SASSAD) severity scale, indicating the disease severity in patients with atopic dermatitis. 11 For this reason, increasing adherence may even have a larger impact on patient-reported outcomes than the improvement of the treatment itself.…”