Psychological factors predict adherence to methotrexate in rheumatoid arthritis; findings from a systematic review of rates, predictors and associations with patient-reported and clinical outcomes

Abstract

Treatment response to methotrexate (MTX) for rheumatoid arthritis (RA) is not universal and non-adherence may partially explain this. The aims of this systematic review were to: (1) summarise existing rates of adherence to MTX, (2) identify predictors of adherence to MTX, and (3) assess the association between non-adherence and patient outcomes. The authors conducted a systematic search of papers published from January 1980 to February 2015 in PubMed, PsycINFO, EMBASE and CINAHL databases. Studies were eligible for inclusion if: (1) MTX was used as monotherapy or in combination with other therapies, (2) MTX was used in an RA or inflammatory polyarthritis population, (3) adherence was defined and measured as the extent to which patients followed their MTX regimen during the period of prescription, and (4) it was an original piece of research. In total, 10 studies met the inclusion criteria and 8 were evaluated as high quality. Rates of adherence ranged from 59% to 107%, and exposed differences in definitions of adherence, study methodologies and sample heterogeneity. A number of potential predictors of MTX adherence were identified; the strongest being related to beliefs in the necessity and efficacy of MTX, absence of low mood, mild disease and MTX monotherapy. Furthermore, 3 studies tested the association of adherence with disease activity as an outcome measure; all 3 found non-adherence associated with poor treatment response. This systematic review shows the importance of adherence to MTX treatment and summarises the associated modifiable factors.

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 .…”

“…In 2003, the World Health Organization estimated that only 50% of patients with a chronic disease were adherent . 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% .…”

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

“…Nonadherence to DMARD has been associated with symptom worsening and increased disability 9,10 , and high adherence has been linked to lower disease activity 11,12 . A previous narrative review found no clear pattern in factors that influence medication adherence in patients with RA 5 , whereas a systematic review of methotrexate (MTX) use in RA suggested improved adherence was associated with belief in the necessity and efficacy of MTX, absence of low mood, mildness of disease, and monotherapy with MTX 13 .…”

“…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.…”