At the European League Against Rheumatism Annual Congress (EULAR 2016) June 8-11 in London, two new studies offered insights on why patients with rheumatoid arthritis (RA) do not adhere to their treatment plan, providing important information on strategies that clinicians can use to improve treatment adherence, which helps reduce healthcare costs and improve treatment outcomes.
According to a press release, the results from the two studies presented at EULAR 2016 highlight that:
- RA patients who experience independence, who seek information, and who have a positive attitude about their disease are more likely to adhere to their treatment plan compared to those who feel less independent and become less actively involved because of joint pain.
- Patient anxiety on starting methotrexate therapy is a predictor of non-response to therapy at six months, which is partly explained by poor treatment adherence.
RA management rests primarily on the use of disease-modifying anti-rheumatic drugs (DMARDs). These agents are commonly characterized by their capacity to reduce or reverse signs and symptoms, disability, impairment of quality of life, inability to work, and progression of joint damage, and tend to interfere with the entire disease process. Non-adherence to DMARDs stops the targets of RA treatment, achieving low disease activity and lessening the radiological disease progression.
“Non-adherence has been shown to be a serious problem in the treatment of RA. The consequences of non-adherence not only affect RA patients’ disease activity, but also the rheumatologist’s treatment decisions, which may lead to higher healthcare costs,” said lead author Dr. Johanna Hazes from the Erasmus Medical Centre in Rotterdam, the Netherlands. “However, it remains unknown as to why so many RA patients do not adhere to their treatment.”
To determine which RA patients are at risk for treatment non-adherence in the first three months, researchers evaluated 259 patients with diagnosis of inflammatory arthritis who initiated treatment with synthetic DMARDs. All patients were interviewed with questions assessing potential adherence predictors, and adherence measured using electronically monitored pill bottles.
Treatment adherence was high in the beginning but then dropped over three months of treatment follow-up. Of the 15 factors that were evaluated to potentially influence treatment adherence, “information seeking” and “having positive expectations about their disease” were the factors linked with adherence. “Adjusting to the pain” was found to be associated with non-adherence to treatment.
The results also showed that factors not associated with treatment adherence included disability; non-specific anxiety; depression; and negative feelings and responses to issues related to patients’ perceptions of the need for their treatment and of any potential harm from their treatment prescription.
Anxiety about initiating treatment with methotrexate was believed to result in poor treatment adherence “Methotrexate is the DMARD of first choice in the treatment of RA; however, response to methotrexate is highly variable,” said lead investigator Dr. Suzan Verstappen of the Centre for Musculoskeletal Research at the University of Manchester in England. “Being able to predict which of our RA patients are likely to not respond would enable us to provide earlier access to alternative drugs with the hope of avoiding disease progression in some of our patients.”
To assess the predictors of treatment response to methotrexate, researchers used questionnaires, case notes, and blood samples from 781 patients with RA. Non-response to therapy was defined as not fulfilling the EULAR criteria for a good response: disease activity score-28 (DAS28) at 6 months, and reduction in DAS28 from baseline to six months greater than 1.2.
“From a long list of lifestyle, clinical, and psychosocial predictors at baseline, BMI, smoking and DAS28 score were each shown to significantly predict non-response six months after patients had started treatment with methotrexate,” Verstappen concluded. “Of particular interest, however, is the role of participant anxiety on starting treatment with methotrexate in predicting response, which is likely to be the result of its negative effect on adherence.”