Medication Adherence of Patients with Selected Rheumatic Conditions: A Systematic Review of the Literature

Abstract

Objective-Nonadherence with medication treatment has been found to occur in large proportions of patients with a broad range of chronic conditions. Our aim was to perform a systematic review of the literature examining adherence with treatments for inflammatory rheumatic conditions to assess the magnitude of the problem in this patient population.Methods-A MEDLINE search of English language literature was performed to identify studies published between January 1, 1985 and November 30, 2007 that evaluated adherence with chronic medications needed in the treatment of rheumatic conditions.Results-A total of 20 articles met the criteria for evaluation, the majority of which focused on the treatment of rheumatoid arthritis. Most of the studies examined the use of nonsteroidal antiinflammatory medications and disease modifying anti-rheumatic drugs. Adherence was assessed based on self-report, pill counts, pharmacy dispensings, openings of pill containers using electronic devices, laboratory assays, and physician assessment. Adherence varied greatly based on the adherence measure used, arthritic condition evaluated and medication under study. Overall, the highest rates of adherence were based on self-reports for a wide variety of medications and conditions (range of persons reporting adherence was 30 to 99%), while the lowest adherence rates were for allopurinol based on pharmacy dispensings (18-26%).Conclusions-Adherence has not been widely examined for most chronic inflammatory rheumatic conditions and the few studies that exist used different definitions and populations, thus limiting any conclusions. However, the current literature does suggest that nonadherence is a substantial problem.

Intentional and unintentional treatment nonadherence in patients with systemic lupus erythematosus

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

“…Although several systematic or comprehensive reviews have evaluated adherence to DMARD in general 7,17,18 , only 1 systematic study, to our knowledge, has specifically evaluated MTX adherence (but not persistence) in patients with RA 13 . Given the prevalence of MTX use and its involvement in combination treatment with biologics, it is important to understand factors that may cause patients to be nonadherent or to discontinue treatment.…”

Safety, Effectiveness, and Treatment Persistence of Golimumab in Elderly Patients with Rheumatoid Arthritis in Real-World Clinical Practice in Japan

“…Indeed, this notion is supported by previous studies demonstrating that poor treatment persistence of biologics can blunt the effectiveness [22,23]. While several studies have revealed that overall treatment persistence of biologic agents in elderly RA patients is not inferior to that in younger RA patients [24,25], large variation in treatment persistence as well as reasons for discontinuation among different biologic agents have been noted [25,26].…”