Background/Purpose:

Knowledge of factors that contribute to non-persistence with disease modifying anti-rheumatic drugs (NP-DMARDs) is essential to improve rheumatoid arthritis (RA) outcomes. Aims of the study were to investigate patient’s motivations and risk factors for NP-DMARDs in a cohort of early Mexican Mestizos patients with RA and traditional DMARDs.

Methods:

 Up to September 2012, data from 149 patients (93% of the entire cohort), who had at least 1 year of follow-up, and one DMARD indication, and 2 consecutive six-months-apart rheumatic evaluations that included assessment of compliance with treatment were reviewed. Compliance was evaluated according to a 22-items questionnaire locally designed that evaluates among others NP-DMARDs and patient´s motivations of NP-DMARDs. Patients had partial health coverage and pay for their medication.

Descriptive statistics and logistic regression models were used. All statistical tests were 2-sided and evaluated at the 0.05 significance level. The study was approved by the internal review board. Written informed consent was obtained.

Results:

Up to cut-off, 715 questionnaires were applied to 149 patients, who had (mean ± SD) follow-up of 58.7 ± 27.9 months and were indicated (mean±SD) DMARDs/patient/follow-up of 2.4±0.7.

Patients were most frequently female (88.6%), middle-aged ([mean±SD] age of 38.5±12.8 years) with lower-middle/lower socio-economic status (87.9%) and (mean±SD) scholarship of 11±3.9 years. 

Ninety-nine (66.4%) patients were NP-DMARDs and filled 330 questionnaires. Multivariate analysis showed that years of formal education (OR: 1.12, 95% CI: 1.1-1.24, p=0.03), perception of at least some difficulty to find arthritis medication (OR: 5.68, 95% CI: 2.48-13, p=0.000) and perception that arthritis medication is expensive (OR: 5.27, 95% CI: 2.1-13.84, p=0.001) at the first evaluation of patient´s compliance were all predictor of NP-DMARDs.

Among the 99 NP-DMARDs patients, 25 (25.3%) were recurrent-NP-DMARDs and accumulated more disease activity than their counterparts ([mean±SD cumulative DAS28] 3.7±2 vs. 2.9±1.7, p=0.04). Also, DAS28 remission was lower among recurrent-NP patients (8 vs. 45, p=0.002).

Combination of both reasons of NP-DMARDs (“Because it was not available at the drugstore” and “Because the medication is very expensive”) when selected by the patient at the first evaluation of compliance was the only variable to predict recurrent NP-DMARD, OR: 4.8, 95%CI: 1.1-20.8, p=0.04. 

Conclusion:

Health systems should provide (first line) treatment for RA as a strategy to improve compliance with therapy and clinical outcomes, particularly in vulnerable populations.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/motivations-for-inadequate-persistence-with-disease-modifying-anti-rheumatic-drugs-in-early-rheumatoid-arthritis-the-patients-perspective/