Non-Adherence to Disease-Modifying Anti-Rheumatic Drugs in Patients with Rheumatoid Arthritis: An Italian Survey

Gerolamo Bianchi¹, Antonio Carletto², Oscar M. Epis³, Crescenzio Scioscia⁴, Angelo Semeraro⁵, Chiara Donati⁶, Laura Bazzichi⁷, Giovanni Lapadula⁸, Luigi Sinigaglia⁹ and Andrea Lo Monaco¹⁰, ¹Div Reumatologia, Ospedale La Colletta, Genoa, Italy, ²Rheumatology Unit, University of Verona, Verona, Italy, ³Rheumatology Unit, A.O. Ospedale Niguarda Ca' Granda, Milan, Italy, ⁴DIM - Sezione di Reuamtologia Università degli Studi di Bari "Aldo Moro", Bari, Italy, ⁵Unità Operativa di Reumatologia ASL Taranto, Taranto, Italy, ⁶Roche S.p.A., Monza, Italy, ⁷Division of Reumatology, Univeristy of Pisa, Pisa, Italy, ⁸D.I.M.I.M.P, Rheumatology Unit - University of Bari, Bari, Italy, ⁹Rheumatology Dep, I.O.G. Pini, Milan, Italy, ¹⁰Ospedale S. Anna, Ferrara, Italy

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: DMARDs, patient engagement, rheumatoid arthritis (RA) and therapy

Session Information

Date: Sunday, November 8, 2015

Title: Rheumatoid Arthritis - Clinical Aspects Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: In patients (pts) with rheumatoid arthritis (RA), the non-adherence to therapy may impair the clinical outcomes, being often associated with the disease flare and increased disability. The objectives of this survey were to confirm previous data about the extent of non-adherence to treatment with conventional disease-modifying anti-rheumatic drugs (cDMARDs) alone or with biological DMARDs (bDMARDs) in a larger sample of RA pts in Italy and to identify the profile of cDMARDs non-adherent pts

Methods: This was the second part of a self-reported survey started in 2014 in RA pts treated with cDMARDs in Italy. In the hospital waiting room, pts were asked to fill out an anonymous paper based questionnaire. Fieldwork: December 3^rd 2014 – March 6^th 2015

Results:

A total of 1,568 RA pts treated with cDMARDs were recruited from 29 Italian centers (females: 72.6%; mean age: 55 years; mean time since RA diagnosis: 9 years; pts already on treatment for other concomitant diseases: 58%): 685 pts (43.7%) were treated with cDMARDs alone and 883 pts (56.3%) were treated in combination with a biologic drug.

Overall, the proportion of pts reporting non-adherence to cDMARDs was 39.2% (n=615): 37.5% (n=257) of pts treated with cDMARDs alone and 40.5% (n=358) of pts treated in combination cDMARD + biologic drug. Among cDMARDs non-adherent pts, 86.3% reported to take “almost always” the cDMARDs treatment, 12% “seldom” and 1.6% “never”, with similar rates for pts treated with cDMARDs alone and in combination with a biologic drug. The main reason given for cDMARDs pts non-adherence was forgetfulness (49.9%); other reasons reported were: side effects fear (25.2%), the feeling they were taking too many drugs (16.6%) and the thought of feeling better (13.5%). Interestingly, 34.5% of the total 615 cDMARDs non-adherent pts did not mention cDMARDs non-adherence to their physician, particularly younger pts (aged ≤ 40 years).

Compared to the overall rate of cDMARDs non-adherence (39.2%), frequency of cDMARDs non-adherence was significantly higher (66.7%) in pts reporting a heavy impact of cDMARDs treatment on their life or an impairment of some aspects of their life, such as social life (55.9%), due to cDMARDs treatment.

Considering pts lifestyle, the rate of cDMARDs non-adherence was higher in pts taking care of family members (non-adherence rate: 43.9%), having an occasional rather than full-time job (49%), rarely practicing sports or hobbies (43.3%), receiving help by family members or caregivers (47.9%), taking also corticosteroids in combination (46.8%)

Conclusion: Results of this second part of the survey confirm that among RA pts cDMARDs non-adherence is quite widespread (39.2%). Moreover, it is an unrecognised phenomenon in a considerable proportion of non-adherent pts (34.5%), who find difficult to talk to their physician about this issue. cDMARDs non-adherence appears strictly related to the impact of cDMARDs treatment on pts quality of life and is higher in pts treated with cDMARDs in combination with a biologic drug (40.5%), in more severely affected pts and in pts treated with more drugs. Lifestyle appears to be less related to treatment adherence, being more adherent pts with a regular way of life

Disclosure: G. Bianchi, None; A. Carletto, None; O. M. Epis, None; C. Scioscia, None; A. Semeraro, None; C. Donati, Roche Pharmaceuticals, 3; L. Bazzichi, None; G. Lapadula, None; L. Sinigaglia, Amgen, Eli Lilly, BMS, Abbvie, 8; A. Lo Monaco, None.

To cite this abstract in AMA style:

Bianchi G, Carletto A, Epis OM, Scioscia C, Semeraro A, Donati C, Bazzichi L, Lapadula G, Sinigaglia L, Lo Monaco A. Non-Adherence to Disease-Modifying Anti-Rheumatic Drugs in Patients with Rheumatoid Arthritis: An Italian Survey [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/non-adherence-to-disease-modifying-anti-rheumatic-drugs-in-patients-with-rheumatoid-arthritis-an-italian-survey-2/. Accessed .

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