Background/Purpose: F. Hoffmann-La Roche Ltd. and Mapi collaborated to develop a medication adherence measure among RA patients taking MTX—the Methotrexate Experience Questionnaire (MEQ). The MEQ aims to facilitate communication between patients and clinicians during consultation to help clinicians identify patients having difficulty with MTX adherence and specific issues leading to nonadherence. The MEQ was developed in accordance with best psychometric practices, including patient interviews, and contains several domains providing a comprehensive picture of drivers and descriptors of adherence issues encountered by RA patients treated with MTX. An observational study was conducted with patients from the PatientsLikeMe (PLM) online community. The aims of the present analysis were to provide preliminary results regarding the MEQ psychometric features and identify drivers of poor adherence in a population of PLM online users treated with MTX for RA.

Methods: This was a cross-sectional study where PLM RA subjects treated with MTX (currently or within the past 6 months) were asked to complete the 4-item Morisky Medication Adherence Scale (MMAS-4) and the MEQ online. The MEQ includes 29 items with 4- or 6-point Likert scale answers. Key psychometric MEQ features were described: acceptability and appropriateness of items (quality of completion, distribution, floor and ceiling effects), construct validity (multi-trait correlation-based analyses), concurrent validity (description and comparison of MEQ scores across MMAS-defined adherence and clinical groups). Linear, logistic, and partial least squares regressions were used to identify drivers of poor adherence.

Results: The population included 217 patients (80.2% aged 40-65 years; 90.8% women) whose mean duration of RA was 9 years (SD ±10.5). The MEQ was well accepted (only 3.2% of completed questionnaires were missing ≥1 MEQ items). Some revisions to the theoretical structure were proposed in the process toward the development of the MEQ scoring algorithm (5 dimension scores were proposed: Perceived benefits of MTX, Convenience aspects of MTX, Drivers of nonadherence to MTX, Negative sides of MTX, Patient information). As expected, convenience and noncompliance scores were highly correlated to MMAS-4 (r=0.661 and 0.661, respectively), while Patient information and Perceived benefits did not show a significant association. Moreover, MEQ convenience, noncompliance, and Negative sides scores discriminated between low, moderate, and high adherence groups as defined by the MMAS-4 (p<0.0001). Multiple drivers of poor adherence were identified, including aspects related to convenience, symptom improvement, how sick the patient felt, patient activities, and patient travel plans.

Conclusion: These preliminary results related to psychometric features of MEQ look promising as the instrument appears to discriminate between low, moderate, and high adherence as defined from the generic MMAS-4 in an online community of patients with RA. Future research includes psychometric validation of the MEQ in patients with clinically diagnosed RA against an objective measure of adherence (prescription claims data).

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/psychometric-features-of-a-new-methotrexate-mtx-specific-adherence-tool-for-use-in-the-management-of-patients-with-rheumatoid-arthritis-ra-preliminary-results-from-an-online-patient-community/