Background/Purpose: Treatment adherence is a major challenge in chronic inflammatory rheumatic diseases, particularly rheumatoid arthritis (RA), with adherence rates ranging from 30 to 80%. Given the impact of non-adherence on disease outcomes, 2019 guidelines highlight the multifactorial nature of non-adherence and the need to clarify contributing factors to. Additionally, an EULAR task force has highlighted the importance of managing treatment adherence in difficult-to-treat RA. 
Based on STRATEGE2 results, we investigated real-life treatment adherence in RA patients treated with methotrexate (MTX) at time of initiation of a first b/tsDMARD and during a two-year follow-up.

Methods: The STRATEGE2 cohort included RA patients who have been treated with MTX for at least 3 months (M) and were eligible for a first targeted biological (bDMARD) or synthetic (tsDMARD) therapy due to RA activity. 
Patients completed the Compliance Questionnaire for Rheumatology (CQR) at baseline, 12M and 24M). This 19-item self-administered questionnaire specifically designed for rheumatology assessed treatment adherence, with a  CQR19≤80 indicating non-adherence (N-Ad). Profiles of N-Ad at all 3 steps were compared to those of patients who were  adherent (Ad) at least once during these steps. In addition, participation in shared decision-making (SDM) was evaluated using a 5-point Likert scale, adapted for both patient and physician use.

Results: Between Feb. 2019 and Dec. 2020, 180 RA patients were enrolled, with 100 patients having an analyzable CQR19 at all 3 steps. Patient were divided in 2 groups: 32 patients were N-Ad throughout the study and 68 were Ad at least once.
At baseline, no significant difference in patient profiles (except for MTX route): 75.0% females, mean age 57.2±12.8 years, diagnosed 6.1±7.8 years previously, treated with MTX for 4.8±5.5 years and a mean MTX dose 18.9±4.2 mg/week. B/tsDMARD management was identical for both groups (92.0% bDMARD and 8.0% tsDMARD initiation).
Over 24 months, the therapeutic strategy showed no difference between the groups: 55.0% had at least one adaptation to their b/tsDMARD treatment and 16.0% discontinued it. The mean dose of MTX decreased overall to 14.9±4.7 mg/week and 21.0% of patients discontinued it. The main difference was the significant (p< 0.05) lower use of MTX SC route in N-Ad vs. Ad at the 3 steps (Baseline: 62.5% vs. 86.8%, 12M: 38.5% vs. 68.3%, and 24M: 38.5% vs. 64.2%).
Over 24M, RA activity decreased in both groups (NS).

Evolution of Patients and Physicians’ perception of SDM participation over 24M:

Conclusion: This analysis identifies 2 characteristics of N-Ad patients compared to those who were Ad at least once. Over 24 months, N-Ad used MTX SC route less than Ad patients and felt less involved in SDM, although this perception is not shared by the physician.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/what-happens-in-rheumatoid-arthritis-treatment-adherence-two-years-after-the-introduction-of-targeted-therapy-results-from-the-stratege2-study/