Predicting adherence to therapy in rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis: a large cross-sectional study

Abstract

ObjectiveThis analysis explored the association of treatment adherence with beliefs about medication, patient demographic and disease characteristics and medication types in rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS) to develop adherence prediction models.MethodsThe population was a subset from ALIGN, a multicountry, cross-sectional, self-administered survey study in adult patients (n=7328) with six immune-mediated inflammatory diseases who were routinely receiving systemic therapy. Instruments included Beliefs about Medicines Questionnaire (BMQ) and 4-item Morisky Medication Adherence Scale (MMAS-4©), which was used to define adherence.ResultsA total of 3390 rheumatological patients were analysed (RA, n=1943; PsA, n=635; AS, n=812). Based on the strongest significant associations, the adherence prediction models included type of treatment, age, race (RA and AS) or disease duration (PsA) and medication beliefs (RA and PsA, BMQ-General Harm score; AS, BMQ-Specific Concerns score). The models had cross-validated areas under the receiver operating characteristic curve of 0.637 (RA), 0.641 (PsA) and 0.724 (AS). Predicted probabilities of full adherence (MMAS-4©=4) ranged from 5% to 96%. Adherence was highest for tumour necrosis factor inhibitors versus other treatments, older patients and those with low treatment harm beliefs or concerns. Adherence was higher in white patients with RA and AS and in patients with PsA with duration of disease <9 years.ConclusionsFor the first time, simple medication adherence prediction models for patients with RA, PsA and AS are available, which may help identify patients at high risk of non-adherence to systemic therapies.Trial registration numberACTRN12612000977875.

<p>Adherence to Subcutaneous Anti-TNF Treatment in Chronic Inflammatory Rheumatism and Therapeutic Patient Education</p>

“…We found that anti-TNF adherence did not differ between patients with different types of CIR; this finding contrasted with the findings of Smolen et al, who demonstrated identical anti-TNF adherence in patients with RA and PsA, but worse adherence in patients with AS. 1 In our study, adherence was not impacted by the disease duration or to the number of sessions attended by the patient. However, adherence was better in older subjects than in younger subjects, consistent with Smolen et al In addition, that study showed that anti-TNF adherence was improved among patients that believed the treatment would be effective, compared to those that worried about the inherent risks of treatment, based on the Beliefs about Medicine Questionnaire.…”

“…This finding was consistent with the good adherence level reported by Smolen et al (70.6-74.1%), in a study of 3390 patients (RA: n=1943; AS: n=812, PsA: n=635), based on the Morisky MMAS-4© questionnaire. 1 However, Smolen et al did not report whether those patients benefitted from TPE. We found that anti-TNF adherence did not differ between patients with different types of CIR; this finding contrasted with the findings of Smolen et al, who demonstrated identical anti-TNF adherence in patients with RA and PsA, but worse adherence in patients with AS.…”

“…Fayet with the Biosecure score. We speculated that the group TPE sessions in our study might have generated false beliefs, brought up by certain patients, which then gave rise to an inverse correlation between fear of treatment and treatment adherence in CIR (1). Regardless of whether that was true, our findings, combined with those in the literature, should encourage Rheumatology departments to improve anti-TNF adherence by offering patients individual TPE consultations, rather than group TPE sessions, when subcutaneous anti-TNF treatment is required.…”

“…In the Smolen study, the percentage of patients that demonstrated good adherence with an anti-TNF agent was 75% for those with RA, 68% for those with AS, and 70% for those with psoriatic arthritis (PsA). 1 Poor patient adherence to treatments has proven to be a major roadblock to effective management. 2 Treatment adherence is determined by the complex interactions of several factors: the disease, drug therapies, demographic and socioeconomic factors, treatment beliefs, the opinions of patients and their friends or family, and the other healthcare system services (advice, education, etc.).…”

“…2 Treatment adherence is determined by the complex interactions of several factors: the disease, drug therapies, demographic and socioeconomic factors, treatment beliefs, the opinions of patients and their friends or family, and the other healthcare system services (advice, education, etc.). 1,3,4 Therapeutic patient education (TPE) is now recognized as a crucial tool in managing conditions like CIR. 5,6 Among the factors likely to improve treatment adherence, TPE has been the most extensively studied, and this approach is supported by the highest level of evidence.…”