Session Information
Session Type: ARHP Concurrent Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose: Medication nonadherence accounts
for more than $100 billion in preventable healthcare costs annually in the US.
Nonadherence to disease-modifying antirheumatic drugs (DMARDs) among patients
with rheumatic diseases likely results in significant morbidity. We investigated
the association between demographic, disease-related and psychosocial factors and
nonadherence to recently initiated DMARDs; the long-term goal is to better tailor
interventions to target patients at highest risk for nonadherence.
Methods: English or Spanish-speaking
patients ≥18 years old who recently started an oral DMARD for a systemic
rheumatic disease were invited to participate. The study took place between
2013 and 2015 at an academic medical center. We identified patients using
electronic medical record review and obtained permission to contact the
patients from the treating rheumatologist. Medications and demographic factors
were ascertained using electronic medical record queries. Trained bilingual research
assistants administered baseline surveys by phone or in person. We measured self-reported
adherence to oral DMARDs using the eight-item Morisky Medication Adherence
Scale (MMAS). We determined disease activity for rheumatoid arthritis (RA) and
other inflammatory arthritis with the Rheumatoid Arthritis Disease Activity
Index (RADAI). Anxiety and depression were assessed with the Mental Health
Inventory (MHI-5) and perceived illness severity using the Brief Illness
Perception Questionnaire. We used descriptive statistics to compare
demographics and survey findings by degree of adherence.
Results: We administered surveys to 92
patients. The mean age was 56.1 years (SD 16.2), 95% were female, 72.8% were
White, 5.4% Black, 2.2% Asian and 19.6% not reported;17.4% identified as
Hispanic. 80.4% had RA or other inflammatory arthritis, 7.6% lupus, and 4.3%
other systemic rheumatic diseases. In terms of medication use, 52.2% recently started methotrexate, 20.7% hydroxychloroquine,
10.9% sulfasalazine, 6.5% leflunomide, 3.3% azathioprine, and 3.3% tofacitinib.
The mean RADAI was 14.7 (SD 9.1). 89.8% of patients had depressive symptoms
(MHI-5<70). The mean adherence score was 6.6 (SD 1.4); 23.9% reported poor
adherence to their prescribed DMARD (MMAS <6), 53.3% borderline (MMAS 6 to <8)
and 22.8% high (MMAS=8). Patients with poor adherence were more likely to be younger
(p=0.01), have more active RA (p=0.05), and more depressive symptoms (p=0.02) (Table).
Conclusion: In this cross-sectional
analysis, the majority of patients who recently started an oral DMARD had
borderline or poor adherence and a significant burden of depressive symptoms. Increased
disease activity, depression and younger age were associated with poorer
adherence. Interventions that target these individuals at high risk for
nonadherence are being tested to determine whether clinical outcomes improve.
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Table. Association of demographic, disease-related and psychosocial factors with degree of adherence as measured by the eight-item Morisky Medication Adherence Scale (MMAS) |
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|
Overall* |
Poor Adherence (MMAS<6) |
Borderline Adherence (MMAS 6-<8) |
High Adherence (MMAS=8) |
p-value** |
|
Age –mean years (SD) |
56.1 (16) |
48 (14.6 ) |
57.1 (15.7) |
62.4 (16.1) |
0.01 |
|
Gender – N (%) |
0.71 |
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|
Female |
87 (95) |
19 (21.8) |
47 (54) |
21 (22.8) |
|
|
Male |
5 (5) |
2 (40) |
2 (40) |
1 (20) |
|
|
Ethnicity |
0.17 |
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|
Hispanic- N (%) |
N=16 (17.4) |
6 (37.5) |
9 (56.3) |
1 (6.3) |
|
|
Non-Hispanic – N (%) |
N=72 (78.2) |
15 (20.8) |
39 (42.4) |
18 (25) |
|
|
Not reported |
N=4 (4.3) |
1 (25) |
1 (25) |
2 (50) |
|
|
Insurance Status (N=86)- N (%) |
0.14 |
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|
Medicaid |
N=11 (12.8) |
5 (45.5) |
4 (36.4) |
2 (18.2) |
|
|
Medicare |
N=28 (32.6) |
6 (21.4) |
13 (46.4) |
9 (32.1) |
|
|
Private |
N=46 (53.5) |
10 (21.7) |
29 (63) |
7 (15.2) |
|
|
Self-pay |
N=1 (1) |
0 (0) |
0 (0) |
1 (100) |
|
|
Rheumatic disease – N (%) |
0.37 |
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RA/psoriatic arthritis/JIA |
N=74 (80.4) |
16 (21.6) |
42 (56.8) |
16 (21.6) |
|
|
Lupus and other rheumatic diseases+ |
N=18 (19.6) |
6 (33.3) |
7 (38.9) |
5 (27.8) |
|
|
RA Disease Activity (RADAI, N=73) – Mean (SD) |
14.7 (9.1) |
16.2 (10.7) |
16.1 (9.1) |
9.8 (5.8) |
0.05 |
|
Depression/Anxiety (MHI-5, N=88)- Mean (SD)++ |
61.1 (9.7) |
57.5 (10.4) |
62.3 (9.6) |
62.2 (8.6) |
0.02 |
|
Illness Perception (N=91) – Mean (SD) |
44.6 (9.9) |
42.3 (12) |
45.1 (9) |
45.8 (9.6) |
0.46 |
|
*N=92 unless otherwise specified **p-values calculated with ANOVA (continuous variables) or Fisher’s exact tests (categorical variables) +Other rheumatic diseases include: mixed connective tissue disease, systemic sclerosis, systemic vasculitis, sarcoidosis, polymyositis, polymyalgia rheumatica, immune-mediated necrotizing myopathy, Behcet’s disease ++Lower MHI-5 scores reflect increased depressive symptoms |
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To cite this abstract in AMA style:
Feldman CH, Massarotti E, Wohlfahrt A, Campos A, Lo Y, Zhang Z, Iversen MD, Solomon DH. Factors Associated with Nonadherence to Recently Initiated Disease-Modifying Antirheumatic Drugs [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/factors-associated-with-nonadherence-to-recently-initiated-disease-modifying-antirheumatic-drugs/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-associated-with-nonadherence-to-recently-initiated-disease-modifying-antirheumatic-drugs/