Background/Purpose: Patients with rheumatoid arthritis (RA) need to take lifelong oral or injectable medication to alleviate their symptoms and prevent disease progression. However, some patients may not adhere or poorly adhere to treatment and have poor understanding of biological agents. Poor or no adherence may be attributed to the following factors: complex regimen for medications, such as methotrexate (MTX), difficulty in self-administration of injectables due to hand deformities, and forgetfulness due to dementia. This study aimed at determining the effect of educating visiting pharmacists regarding administration of oral medication and injectables for patients with RA who poorly adhere to treatment regimens.

Methods: A prospective analysis was performed by enrolling 21 patients with RA who were treated with different types of medication, including self-injectable biological agents. Two cases were excluded because one had been added on subcutaneous tocilizumab and the other on MTX with increased dosage. The remaining 19 cases did not have any change in their treatment, including dosage or intervals between drug administration, just before and after the pharmacist visit. Baseline characteristics, such as age, Steinblocker Stage and Class, disease duration, use of biological agents, use of MTX and its dosage, use of prednisolone (PSL) and its dosage, presence of dementia, and living or not living alone, were assessed. DAS28-ESR, SDAI and CDAI as markers of RA disease activity were evaluated just before and after the pharmacist visit.

Results: Mean ± SD were as follows: age (years), 74.4 ± 6.1; Stage I, 1; II, 4; III, 6; IV, 8; Class 1, 0; 2, 7; 3, 8; 4, 4; disease duration (months), 144.2 ± 114.5; use of biological agents; 36.8%; use of MTX and its dosage (mg/week), 84.2% and 6.6 ± 2.7; use of PSL and its dosage (mg/day), 47.4% and 4.4 ± 1.2; presence of dementia, 10.5%; living alone, 42.1%. The mean values of DAS28-ESR, SDAI, and CDAI just before and after the pharmacist visit showed improvements; they were 3.56 ± 1.46 and 3.12 ± 1.16 (p = 0.084), 7.99 ± 6.88 and 4.39 ± 3.47 (p = 0.0176), and 6.85 ± 5.74 and 3.90 ± 3.18 (p = 0.0148), respectively. All patients reported satisfaction with the overall effectiveness of the care.

Conclusion: Adherence to treatment in patients with RA may decline with increasing age. For such patients, education regarding oral and injectable medication may be useful in controlling RA activity and avoiding any adverse effects due to consumption of wrong medication. This finding is important for better and safer management of patients with RA in the ageing communities in Japan and other developed countries.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/efficacy-of-educating-visiting-pharmacists-regarding-drug-administration-for-patients-with-rheumatoid-arthritis-who-poorly-adhere-to-treatment-regimens/