Session Type: Abstract Submissions (ACR)
Background/Purpose: A recent meta-analysis of aTNF and abatacept clinical trials established in those drugs that the efficacy of combination therapy with biologic is superior to methotrexate for remission (1). Therefore, non-adherence to cDMARDs prescribed in combination with a biologic may reduce the benefit obtained with these agents.
Objectives: To evaluate the adherence to cDMARDs and biologics in RA patients from both a rheumatologist’s and patient’s perspective.
Methods: A panel of French representative rheumatologists (rheums) were questioned on their perception of their patient’s adherence to cDMARDs and were asked to collect data (age, gender, disease duration, disease activity, treatment characteristics) on their five next patients treated with biologic in combination with cDMARDs and in monotherapy and seen between Nov. 12, 2012 –Feb. 21, 2013. Each included RA patient was invited to complete a self-administered questionnaire (SAQ) on treatment adherence. Adherence to cDMARDs and BT was assessed by the Morisky Medication Adherence Scale (MMAS-4)(2).
Results: This survey included 121 physicians, who collected data on 814 biologic-treated RA patients of whom 445 were treated in combination with cDMARDs. SAQ was returned by 82% (n=365) of these 445 patients. Regarding non-adherence to cDMARDS, 21% of rheums estimated this situation as frequent. In concordance with that, rheums considered that, among their RA patient pool, the mean proportion of patients non-adherent to cDMARDs was 17%. In contrast, the MMAS-4 showed that 35% of patients presented a medium/low adherence (2) to cDMARD. No differences in terms of age, gender, disease duration and disease activity were observed between high adherent and medium/low adherent patients. Patients highly adherent to cDMARD were significantly more often highly adherent to their biologic (90% vs 61%) compared to medium/ low adherent patients. Additionally, the main reasons for cDMARD dose reduction or dose spacing from a patient’s perspective were adverse events (27%), on physician’s advice (24%), forgotten (24%), convenience (23%) and lassitude (17%). Reasons given by rheums were intolerance (72%), lassitude (48%) and disease remission (36%). Over 90% of interviewed rheums evaluated their patients’ adherence, mainly by questioning the patient; 61% did it systematically and 31% frequently. While 23% of patients declared informing their treating rheums of their lack of adherence to cDMARDs, rheums declared being informed only by 17% of their patients.
Conclusion: Adherence to cDMARD in RA patients treated in combination with a biologic should be taken into consideration in patient management as this survey showed that it concerns around 35% of these patients, which is a more frequent situation than expected by their treating rheums. Tools to evaluate patients’ adherence should be developed to help physicians to detect this situation.
1. Kurya B, Arkema EV, Byker VP, Keystone EC Ann Rheum Dis 2010,69:1298-304
2. Morisky DE, Green LW, Levine DM. Med Care 1986; 24:67-74
J. C. Balblanc,
Roche, Pfizer, BMS,
Roche, Pfizer, BMS,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/adherence-to-conventional-disease-modifying-anti-rheumatic-drugs-cdmards-in-rheumatoid-arthritis-ra-patients-treated-in-association-with-a-biologic-a-french-cross-sectional-survey/