Background/Purpose: The treatment options for chronic inflammatory rheumatism (CIR) have grown over the last few years with the emergence of anti-tumor necrosis factor (anti-TNF) agents. Patients’ adherence to this treatment, however, appears suboptimal (Smolen et al, 2019). Given that therapeutic patient education (TPE) is now a recognized factor for improving treatment compliance, we sought to evaluate adherence to subcutaneous anti-TNF therapies by means of the Morisky Medication-Taking Adherence Scale-4 items (MMAS-4^©) (Morisky and al, 1986; Morisky and al, 1990; Morisky & DiMatteo, 2011) among patients with CIR (rheumatoid arthritis [RA], ankylosing spondyloarthritis [AS], and psoriatic arthritis [PsA]) benefiting from different models of TPE.

Methods: This is a retrospective, observational monocentric study of current care practices. We evaluated patients receiving subcutaneous anti-TNF agents and benefitting from TPE from 2009 to 2013, categorized according to educational model (M1:individual informative consultation; M2: individual TPE; M3: individual and group TPE sessions). For all educational models, the patients were informed of the potential benefits and risks of the treatments. Adherence was assessed by means of the MMAS-4^© as follows: good adherence (MMAS-4^©  = 4), moderate adherence (MMAS-4^© = 2-3), and poor adherence (MMAS-4^©  = 0-1). 

Results: In total, 193 patients were included, comprising 124 women. The mean population age was 53.3 ± 14.8 years old; the mean CIR duration was 10 years [5; 18], with 113 patients suffering from RA, 73 from AS, and seven from PsA. Of the 193 patients, 107 (55.4%) received etanercept, 58 (30.1%) adalimumab, 11 (5.7%) certolizumab, and 17 (8.8%) golimumab. A total of 146 (75.7%) patients presented good adherence, 34 (17.6%) moderate adherence, and 13 (6.7%) poor adherence. The M1 model was followed by 92 patients, M2 by 80, and M3 by 21, with lower adherence observed in the M3 group compared to M1 and M2 (p=0.04). Old age was the only factor correlating with good adherence (p = 0.005). Level of knowledge had no significant impact on adherence (p=0.91). In this study, a similar rate of good adherence (70.6% – 74.1%) was found to that of the European-wide study by Smolen involving 3,390 CIR patients using the MMAS-4©. We found that the older subjects of our study presented the best treatment adherence, as was also observed by Smolen. As regards the specific educational model, we demonstrated that adherence dropped in patients receiving both individual and group TPE compared to those attending only individual TPE sessions or simple informative consultations. We were unable, however, to refer to other works from the literature, and it is possible that the group TPE analyzed in our study generated false beliefs introduced by certain patients. Actually, fear of treatment was shown to be inversely correlated to treatment compliance in CIR.

Conclusion: Our study demonstrated good adherence to anti-TNF treatment in patients receiving treatment education, particularly when it took the form of individual sessions.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/adherence-to-subcutaneous-anti-tnf-therapies-in-chronic-inflammatory-rheumatism-and-therapeutic-education/