Background/Purpose:

Methotrexate has become the mainstay of DMARD treatment in Rheumatoid Arthritis and is also used in other rheumatological conditions. It is a drug that carries many tolerability problems with 56 to 85% prevalence of adverse symptoms, even in patients who continue on therapy (Robinson et al 2015). Adherence to drug regimes is not thought to be good with the WHO estimating that 40% of patients not being fully adherent. In a situation where there are also tolerability problems then adherence may be worse. We were interested to explore the views of patients who were on stable ongoing doses of methotrexate about their adherence.

Methods: 450 patients from seven units spread across the UK and Ireland who were taking a stable dose of methotrexate, and planning to continue on it, were asked about how often they had either “forgotten” or “chosen” not to take their methotrexate and for how many weeks. Two centres surveyed 100 patients whilst the other five centres surveyed 50 patients.  In four centres the patients were asked to complete the questionnaire by a doctor and in the other three by a nurse.

Results: A total of 48 (11%) patients revealed that they had chosen to miss one or more doses in the past year. This varied from 2 (4%) patients in the Barnsley centre to 13 (26%) patients in the North Tyneside centre.  Patients reported forgetting to take their Methotrexate more readily; 95 (21%) of the whole group.  The variation in this reporting was interesting – zero in Barnsley and 25 (50%) in Waterford the only difference being that the survey was carried out by a doctor in Barnsley and a nurse in Waterford.

Overall, in the 4 centres where the survey was completed by a doctor (300 patients were surveyed), 25 (8%) patients said they had chosen not to take their Methotrexate for at least 1 week and 36 patients (12%) said that they had forgotten to take it.  In the 3 nurse centres, (150 patients were surveyed), the figures were higher; 23 (15%) patients said that they had chosen not to take their Methotrexate for 2 – 4 weeks and 59 (39%) patients said they had forgotten to take it for 1 – 6 weeks.

Conclusion: There is a substantial amount of missed Methotrexate. Patients seem more comfortable to admit to forgetting rather than choosing to miss drug. Patients seem more comfortable to admit to missing drug to nurses rather than doctors. Studies of adherence need to take account of how and who asks the questions.

Reference

Robinson et al 2015 A multi-centre Survey of Tolerability and Adherence for Patients on Regular Methotrexate Rheumatology  54 (suppl 1) i36-i37

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