Background/Purpose: To evaluate the adherence to treatment with Tofacitinib in patients with Rheumatoid Arthritis (RA) using both versions of the self-questionnaire Compliance Questionnaire Rheumatology: CQR19 and CQR5. Secondary objectives were to determine the variables associated with adherence to Tofacitinib and to compare the performance of both questionnaires.

Methods: A cross-sectional study was carried out. We included patients ≥18 years old, with a diagnosis of RA according to ACR-EULAR 2010 criteria under treatment with Tofacitinib. Sociodemographic data and clinical disease characteristics, such as disease duration, Rheumatoid Factor and anti-CCP status, ESR (mm/h), CRP (mg/l) pain and global disease  assessment by Numerical Visual Scale (NVA), joint count (28), DAS28, presence and duration of morning stiffness were recorded. Previous treatments (b-DMARD and c-DMARD), concomitant treatments,date of beginning and dose of Tofacitinib (5 mg BID or 11 mg XR), date of discontinuation and its reasons (adverse events (AE) or lack of provision) were consigned. All patients completed self-questionnaires CQR19 and CQR5,  CQR19 includes 19 items evaluated by Likert scale of 4 points with a final value of 0 (no adherence) to 100 (perfect compliance). CQR5 is a simplified version, which includes 5 items of the original CQR19, and was previously validated. Statistical analysis: Descriptive statistics. T-test or Mann Whitney to compare the continuous variables, Chi² test or Fisher’s exact test to compare  the categorical ones. Kappa concordance index. Multiple logistic regression in order to determine variables associated with adherence.

Results: We included 52 patients, 82.7% women, with a median age (m) of 57.7 years, disease duration m 16 years. 63.5% had comorbiditiesand 27% were smokers. DAS28 m 2.25. 65.4% had received b-DMARD prior to Tofacitinib. 86.5% of the patients treated with Tofacitinib used 5 mg BID and 48% received Tofacitinib as monotherapy. In 52% the concomitant treatment was: Methotrexate 63% and Leflunomide 33.3%. The median time of Tofacitnib treatment was 13 months. 40,4% patients temporarily suspended treatment and in 50% of the cases, it was due to infections: 4 cases of Herpes Zoster, 4 lower urinary tract infections and 2 pneumonias acquired from the community and the rest of the cases for other reasons, such as scheduled surgeries and/or lack of provision. All the events were solved without complications. Only one patient permanently stopped treatment due to lack of provision. Median CQR19 was 89.5. The 84.6% had an adherence ≥ 80%. The variables significantly associated with adherence ≥ 80% were the presence of comorbidities [70.5% vs 29.5% (p = 0.014)] and older age (60 ± 9 years old vs. 45 ± 6 years old, p = 0.033). Using the CQR5, a similar percentage of patients (82.7%) were adherent, however, the concordance with CQR19 was low (ƙ: 0.227).In the multivariate analysis, older age was the only variable independently associated with greater treatment adherence [OR: 1.09 (95% CI 1.06-1.18), p = 0.037].

Conclusion: The treatment adherence of Tofacitinib was very good for both presentations. Older age was associated with higher adherence. The agreement between the questionnaires CQR19 and CQR5 was low.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/performance-of-cqr5-vs-cqr19-in-the-evaluation-of-adherence-to-tofacitinib-in-daily-clinical-practice/