Non-persistence and non-adherence to MTX therapy in patients with rheumatoid arthritis: a retrospective cohort study based on German RA patients

Abstract

ObjectiveThis study aimed to assess the level of nonpersistence (NP) and nonadherence (NA) to methotrexate (MTX) therapy in German patients with rheumatoid arthritis (RA).Materials and methodsBased on German claims data, RA patients who received a MTX therapy (subgroup: treatment-naive patients) were analyzed. NP was defined as treatment gap >12 weeks. Regarding NA, it is the overall medication possession ratio (MPR) during an observational period of 12 or 24 months after therapy, and the MPR is calculated only for the periods of therapy continuation; NA was defined as MPR <80%.ResultsA total of 7,146 RA patients who received at least one MTX prescription (subgroup: 1,211 treatment-naive patients) could be observed (mean age: 64.4 years, 73.6% female). Percentage of NP patients among MTX-naive patients after 6, 12 and 18 months was 16.7%, 34.0% and 36.7%, respectively. After MTX therapy discontinuation, 39.9% had restarted their MTX therapy, 13.8% had received another non-MTX synthetic disease-modifying antirheumatic drug (sDMARD), 8.1% had biological DMARD (bDMARD) and 49.2% had not received any DMARD prescription at all. Overall, 12- and 24-month MPRs for MTX therapy were 83.0% and 76.5% with a percentage of NA patients of 25.8% and 33.8%, respectively. During periods of general treatment continuation, the percentage of patients with an MPR <80% was 6.5%.ConclusionNP to MTX treatment seems to be common in one-fourth of German patients with RA. An additional number of patients, at least 6.5%, are also affected by NA. A considerable percentage of RA patients who discontinued MTX therapy do not receive any follow-up DMARD therapy.

Mobile Phone Text Messages and Effect on Treatment Adherence in Patients Taking Methotrexate for Rheumatoid Arthritis: A Randomized Pilot Study

“…Its treatment is now well codified; MTX is the first‐line drug and is usually maintained when biologics become necessary . Various studies suggest that adherence may be suboptimal in 25% of patients taking MTX . In the current study, the proportion of nonadherent patients was slightly higher (close to 40%), since the use of a combination of scores is known to avoid the overestimation of adherence .…”

“…In RA, the estimated percentage of patients with good adherence to MTX ranges from 59% to 100%, depending on the evaluation method used . In a pooled analysis of 13,358 patients in published MTX adherence studies, this percentage was 75.6% . Studies based on electronic medication event monitoring systems gave similar results .…”

Potential Benefits of the Self-Administration of Subcutaneous Methotrexate with Autoinjector Devices for Patients: A Review

“… 25 If focused on RA several studies have also shown different estimates of MTX adherence because of the heterogeneity in the assessment methods. 12 For instance, MPR, the Compliance Questionnaire Rheumatology (CQR), the Visual Analogue Scale (VAS), the Medication Event Monitoring System (MEMS), drug record registry, claims data, and the Medication Adherence Report Scale (MARS-5) 12 , 13 , 15 have been used throwing a variety of results that do not allow to build a clear pattern of factors that influence adherence and persistence.…”

“…In short, a therapy framework should meet patient circumstances for optimal efficacy and more effective use of healthcare resources. [1][2][3][4][9][10][11] Treatment adherence in RA has been extensively investigated and reviewed in several metaanalyses [12][13][14][15] that show suboptimal compliance, especially to the reference therapy methotrexate (MTX). The subcutaneous (SC) formulation of MTX, unlike the oral delivery, is the best option in pursuing a higher efficacy and better tolerability; but while the route of administration does not appear to influence drug adherence in RA, 14,[16][17][18][19][20][21][22] some difficulties associated with syringe use may difficult the use of the SC delivery.…”

Split Dosage Weekly Regimen of Oral Methotrexate is Associated With Improved Side Effect Profile in Rheumatoid Arthritis Patients: A Quasi-experimental Study.

“…Skipping of dosage and non-compliance to MTX has been a factor reported previously in our population as well as in international studies due to its adverse events profile. 5 , 6 …”