Nonadherence to disease modifying antirheumatic drugs in the first year after diagnosis: comparing three adherence measures in early arthritis patients

Pasma, Annelieke; Boer, Ethan den; Spijker, Adriaan van ’t; Timman, R.; Bemt, Bart van den; Busschbach, Jan J. V.; Hazes, J. M. W.

doi:10.1093/rheumatology/kew247

Cited by 30 publications

(34 citation statements)

References 26 publications

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“…Similar to this current study, several other studies have also used the CQR for assessing adherence in people with RA. A study in Spain with the sample size of 234 patients found 79.1% of patients as adherent; a study in Belgium found 85.7% were adherent (n = 129) and a study in Netherlands found adherence of 70%, 60.9%, 55.2% and 59.2% after 3, 6, 9 and 12 months from diagnosis (n = 170, 156, 143, 142) . The findings from this study and previous studies suggest that medication adherence in people with RA is higher in European countries than Middle Eastern countries.…”

Section: Discussionsupporting

confidence: 46%

Medication adherence and cost‐related medication non‐adherence in patients with rheumatoid arthritis: A cross‐sectional study

et al. 2019

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Aim First, to assess the clinical characteristics and medication adherence to oral rheumatoid arthritis (RA) medications in patients with RA. Second, to examine adherence determinants with a focus on the effect of medication out‐of‐pocket (OOP) costs on medication adherence to oral RA medications. Lastly, to examine cost‐related medication non‐adherence (CRN) in patients with RA. Methods A cross‐sectional study of patients with RA was conducted at rheumatology outpatient clinics in Shiraz, Iran. The data collection survey consisted of 5 sections including demographic questions, disease‐related questions, Compliance Questionnaire Rheumatology (CQR), CRN questions and an open‐ended question. SPSS version 24 was used for analysis. Results A total of 308 completed surveys were collected. Adherence to oral RA medications was 40.3%. Just under 20% of participants were biologic disease‐modifying antirheumatic drugs (bDMARDs) users and these bDMARDs users were 0.82 times less likely to be adherent to their oral RA medications compared to non‐bDMARDs users (P < 0.05). There was no statistically significant association between OOP costs and adherence to oral RA medications (P > 0.05). However, 28.7% of participants reported not refilling, delaying to refill, skipping doses or taking smaller doses due to cost. In findings of the open‐ended question, medication costs and affordability were the most commonly mentioned barriers to medication adherence. Conclusion Non‐adherence to oral RA medications was prevalent among Iranian patients with RA and OOP costs were a barrier to medication adherence.

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Section: Discussionsupporting

confidence: 46%

Medication adherence and cost‐related medication non‐adherence in patients with rheumatoid arthritis: A cross‐sectional study

et al. 2019

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“…The relationship between MMAS-8 and MPR was evaluated using Pearson’s correlation. We expected the correlation between MMAS-8 and MPR to be weak to moderate as shown in previous studies in other therapeutic areas 20–22…”

Section: Methodsmentioning

confidence: 68%

Utility of the Morisky Medication Adherence Scale in gout: a prospective study

Tan¹,

Teng²,

Chong³

et al. 2016

PPA

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BackgroundThe outcomes of any chronic illness often depend on patients’ adherence with their treatment. A tool is lacking to assess adherence in gout that is standardized, allows real-time feedback, and is easy to understand.ObjectiveWe set out to evaluate the utility of the 8-item Morisky Medication Adherence Scale (MMAS-8) in monitoring medication adherence in a multiethnic Asian gout cohort on urate-lowering therapy (ULT).MethodsThis cohort study recruited patients with gout where baseline and 6-monthly clinical data, self-report of adherence, and health status by Gout Impact Scale (GIS) and EuroQoL-5 dimension 3 levels were collected. Those who received at least 9 months of ULT were analyzed. Convergent and construct validities of MMAS-8 were evaluated against medication possession ratio (MPR) and known groups, clinical outcomes, and patient-reported outcomes. Internal consistency and test–retest reliability were assessed using Cronbach’s alpha and intraclass correlation coefficient (ICC), respectively.ResultsOf 91 patients, 92.3% were male, 72.5% Chinese with mean age 53.5 years. MMAS-8 (mean 6.17) and MPR (mean 96.3%) were poorly correlated (r=0.069, P=0.521). MMAS-8 did not differ between those who did or did not achieve target serum urate (SU) <360 µmol/L (P=0.852); or among those whose SU improved, stagnated, or worsened during follow-up (P=0.777). Adherence was associated with age (β=0.256, P=0.015) and education level (P=0.011) but not comorbidities, polypharmacy, or flare frequency. Concerns for medication side effects and anxiety or depression were associated with lower MMAS-8 (P<0.005). Internal consistency was acceptable (α=0.725) and test–retest reliability was satisfactory (ICC =0.70, 95% confidence interval [CI] 0.36–0.88).ConclusionMMAS-8 had limited construct validity in assessing medication adherence to ULT in our gout patients. Nevertheless, it identified patients bothered or worried about ULT side effects, and those with underlying anxiety or depression, for whom targeted education and coping support may be useful.

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“…There are a number of different methods which have been developed to measure MTX and its metabolites including assays that can detect MTX polyglutamate (MTXPG). However, in a recent study by Pasma et al, no correlation of measurement of MTXPG was found with a Medication Event Monitoring System that registers openings of the medication package; the findings did not, therefore, support the measurement of MTXPG as a biomarker of adherence 21. One possible explanation is the long t 1/2 of MTXPG; the time when MTXPG levels become undetectable, can range from 2 to 32 weeks 22…”

Section: Discussionmentioning

confidence: 89%

Development and validation of a methotrexate adherence assay

et al. 2019

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BackgroundThe first-line therapy for rheumatoid arthritis (RA) is weekly oral methotrexate (MTX) at low dosages (7.5–25 mg/week). However, ~40% of patients are non-adherent which may explain why some do not respond and need to start more expensive biological therapies. To monitor adherence more accurately and develop strategies to improve it, a validated objective MTX adherence test is required.ObjectiveTo develop and validate the diagnostic accuracy of a novel MTX adherence assay using high-performance liquid chromatography–selected reaction monitoring– mass spectrometry (HPLC-SRM-MS) based biochemical analysis of drug levels.Methods20 patients with RA underwent MTX pharmacokinetic assessment using HPLC-SRM-MS MTX plasma concentration analysis over a 6-day period. Directly observed therapy was the reference standard. Pharmacokinetic model validation was performed using independent plasma samples from real-world patients (n=50) with self-reported times of drug administration. Following assay optimisation, the sensitivity of the assay to detect adherence was established using samples from an observational cohort study (n=138).ResultsA two-compartment pharmacokinetic model was developed and validated. Simulations described the sensitivity required for MTX detection over 7 days; subsequent assay optimisation and retesting of samples confirmed that all patients were correctly identified as MTX adherers. Using real-world samples, the assays sensitivity was 95%.ConclusionNon-adherence to MTX is common and can have a significant effect on disease activity. HPLC-SRM-MS plasma analysis accurately detects MTX adherence. The validated objective test could easily be used in clinic to identify patients requiring adherence support.

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Nonadherence to disease modifying antirheumatic drugs in the first year after diagnosis: comparing three adherence measures in early arthritis patients

Abstract: Associations between the three measures are weak. Explanations are individual differences in the uptake of MTX, and little variance in adherence between patients. Moreover, the measurement domains differ: perceptions (CQR), behaviour (MEMS) and pharmacokinetics (MTX).

Cited by 30 publications

References 26 publications

Medication adherence and cost‐related medication non‐adherence in patients with rheumatoid arthritis: A cross‐sectional study

Medication adherence and cost‐related medication non‐adherence in patients with rheumatoid arthritis: A cross‐sectional study

Utility of the Morisky Medication Adherence Scale in gout: a prospective study

Development and validation of a methotrexate adherence assay

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