AT THE EULAR 2017 CONGRESS
MADRID (FRONTLINE MEDICAL NEWS) – Negative beliefs and uncertainty regarding treatment with methotrexate, as well as dislike for the drug, contribute the most to rheumatoid arthritis patients’ nonadherence to the therapy, with one study finding that about one-third were nonadherent at the time they were eligible to start biologic therapy.
The French cross-sectional survey of 244 patients who were not responding to methotrexate found that 34% actually had poor adherence, including 54% who skipped doses and 38% who temporarily stopped treatment without their doctors’ recommendation. In comparison, patients who were deemed adherent had a lower rate of skipping doses (15%) or temporarily stopped treatment without their doctors’ recommendation (4%), both of which were statistically significant differences, Catherine Beauvais, MD , reported at the European Congress of Rheumatology. Nonadherence was defined as taking less than 80% of doses, according to the CQR19 ( Compliance Questionnaire for Rheumatology ).
“We have identified profiles of adherence,” Dr. Beauvais of Saint-Antoine Hospital in Paris commented in an interview.
“Among nonadherent patients, there are two profiles,” she added. “We have patients who are not responding to methotrexate but they also have negative beliefs, low levels of support, and they have professional impairment. [Then,] there are patients who do not like their treatment [although it is being well tolerated].”
The other profiles identified were of patients with good adherence to methotrexate with a higher or lower impact on patient outcomes.
In a poster presentation , Dr. Beauvais and her coauthors suggested that the “detection of patients’ profiles may allow targeted strategies to improve or maintain adherence.”
The FORGET survey was conducted over a 3-month period starting in July 2016. A total of 78 rheumatologists recruited patients who were inadequately responding to methotrexate and, thus, eligible to start biologic treatment for rheumatoid arthritis. Both the rheumatologists and the patients completed questionnaires, with 200 questionnaires being completed by patients and their rheumatologist.
As might be suspected for an RA population, 72% of respondents were women, with a mean age of 54 years. Over half (58%) had at least one comorbidity, and the mean disease activity score in 28 joints at the time of the survey was 4.07.
Significant factors for nonadherence were feeling constrained about taking treatment, cited by 29% of respondents; feeling “less good” with a change in dosage (31%); and feeling that treatment was “doing me more harm than good” (19% of respondents).
Surprisingly, most rheumatologists seemed to be unaware of their patients’ lack of adherence to their medication, despite saying that they asked about adherence in more than 80% of their patients.
Rheumatologists proposed the addition of a biologic to methotrexate more often if patients were nonadherent than if patients showed good compliance (91% vs. 68%; P less than .01).
Effect of patient attitudes on compliance
A team of U.K. researchers evaluated how attitudes toward treatment with methotrexate affected patients’ compliance in a separate poster presentation at the meeting.
PhD student Holly Hope and her associates at the University of Manchester (England) reported data from the Rheumatoid Arthritis Medications Study (RAMS) in which a random sample of 50 patient diaries were examined to construct a framework, which was then used to evaluate 200 patient diaries for beliefs surrounding methotrexate treatment.
RAMS is a 1-year observational study of patients with RA who are starting treatment with methotrexate. Patients recruited into the study completed weekly diaries, noting whether they took methotrexate (adherence) and, if not, their reasons for not doing so. Patients were deemed nonadherent if they did not take methotrexate correctly for 90% of the time over a period of 6 months.
Lower adherence was significantly associated with negative or uncertain views about treatment, with an odds ratio of 2.7. Conversely, being positive or certain about treatment lowered patients’ odds of being nonadherent (OR, 0.32).
“People who are uncertain about how to attribute illness events are less likely to adhere within the first 6 months of starting methotrexate therapy,” Ms. Hope and her coauthors observed.
“Encouraging patients to actively monitor their progress with therapy and providing them with support to understand likely effects of methotrexate may help optimize disease-modifying antirheumatic drug use,” they concluded.
Ms. Hope and Dr. Beauvais had no conflicts of interest to disclose. The FORGET survey was funded by Chugai Pharma France.
