Assessment of the adherence to disease-modifying drugs in patients with chronic inflammatory rheumatic diseases: Results of a survey of 1594 patients - 12/03/19

Doi : 10.1016/j.jbspin.2019.01.023

Clementina López-Medina ^a,^b,^c,^⁎ , Anna Moltó ^a,^b, Franck Gérald ^d, Madeleine Dubremetz ^e, Laurent Grange ^f,^g, Gérard Thibaud ^h, Bénedicte Charles ⁱ, Delphine Lafarge ^j, Catherine Beauvais ^k, Laure Gossec ^l,^m, Maxime Dougados ^a,^b
^a Département rhumatologie, hôpital Cochin, 75014 Paris, France
^b Inserm (U1153), clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, 75014 Paris, France
^c Université de Cordoba (UCO), 14004 Cordoba, Spain
^d Action contre les spondylarthropathies, 06300 Nice, France
^e Association Française des polyarthritiques et des rhumatismes inflammatoires chroniques (AFPric), 75011 Paris, France
^f Association Française de lutte anti rhumatismale (AFLAR), 75013 Paris, France
^g Service de rhumatologie, CHU de Grenoble Alpes, hôpital Sud, 38130 Grenoble, France
^h Association nationale de défense contre l’arthrite rhumatoïde (ANDAR), 34080 Montpellier, France
ⁱ Association France Psoriasis, 75019 Paris, France
^j Association France spondyloarthrites (AFS), 19000 Tulle, France
^k Département rhumatologie, Saint-Antoine hospital, assistance publique-Hôpitaux de Paris, 75012 Paris, France
^l Département rhumatologie, hôpital Pitié Salpêtrière, 75013 Paris, France
^m Sorbonne université, Institut Pierre Louis d’épidémiologie et de santé publique, AP–HP, 75013 Paris, France

^⁎Corresponding author at: Département rhumatologie, hôpital Cochin, rue de Fbg Saint-Jacques, 75014 Paris, France.Département rhumatologie, hôpital Cochinrue de Fbg Saint-JacquesParis75014France

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Abstract

Objectives

a) to describe the self-reported adherence to disease modifying drugs (DMARDs) (methotrexate and biological DMARDs) among patients with chronic inflammatory rheumatic diseases (CIRDs); b) to assess factors associated with non-adherence.

Methods

An observational, cross-sectional, nationwide study was conducted through the use of an electronic survey, which was released via patient organizations in France to rheumatic patients. The main outcome was the rate of non-adherence to DMARDs, which was evaluated with the following question “Have you ever tried to stop or space out your treatment in contrast to what was planned with your doctor?” A positive answer was considered “low adherent”. Sociodemographic variables, type of CIRD and treatment information were also collected. Factors associated with low adherence to methotrexate and bDMARDs were explored by univariate and multivariate logistic regressions.

Results

Among the 1594 participants who completed the survey, 795 (49.9%) were receiving methotrexate and 709 (44.5%) bDMARDs. A total of 159 (20.0%) were identified as low adherents to methotrexate, and being a woman was independently associated with low adherence (OR 1.90 [95% CI 1.07 – 3.36)] to this drug. Regarding bDMARDs, 177 (25.0%) were identified as low adherent, and the factors independently associated with low adherence were being employed (OR 1.47 [95% CI 1.04 – 2.09]) and no concomitant use of methotrexate (OR 0.51 [95% CI 0.36 – 0.73]).

Conclusions

This study suggests that more than 20% of CIRDs patients are low adherent to their DMARDs, and this is more frequent when bDMARDs are administered as a monotherapy.

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Keywords : Adherence, Disease-modifying drugs, Rheumatic disease