Abstract
Background:In chronic rheumatic diseases, non-adherence to treatment is associated with a progression of disease and an increased morbidity (1). In spondyloarthritis (SpA), improving patients’ knowledge on their subcutaneous biologic disease-modifying antirheumatic drugs (bDMARDs) is a key factor to enhance medication adherence (2). The patient information has to ensure the acquisition of safety skills regarding their treatment management.Objectives:To evaluate the impact of a pharmacist’s educational interview on knowledge and therapeutic adherence of subcutaneous bDMARDs in patients with SpA.Methods:Population and study design:consecutive adult patients with well-controlled axial SpA, stable on subcutaneous bDMARDs were enrolled in a randomized, controlled, single-center, open-label, 6-months trial.Intervention:A pharmacist’s educational interview provided information on bDMARDs management at baseline in the intervention group (IG) and at month 6 (M6) in the control group (CG). A booklet containing essential information was given to the patient.Intervention allocation:After written consent, the study treatment was randomly allocated via a computer program by simple randomization, with an allocation ratio of 1:1.Outcome measures:The change of a weighted knowledge score (0 – 100) concerning the bDMARDs management and the change in the Medication Possession Ratio (MPR) at M6 were primary outcomes. The changes in disease activity (BASDAI) and patients’ satisfaction regarding the pharmacists’ interview were secondary outcomes.Statistics:Changes in knowledge score, MPR and BASDAI were compared between the two groups using the T-Student test. Statistical analysis was performed in intention-to-treat. Missing data was handled with multiple imputations.Results:Patients’ characteristics at baseline were comparable among the 89 included patients (46 in IG, 43 in CG). The means ± SD of the knowledge score were 75.3 ±14.2 versus 73.0 ±13.2 and 86.3 ±12.6 versus 76.0 ±14.1 in the IG versus CG at baseline and at M6, respectively. The patient’s knowledge score improved at a greater magnitude in the IG (+11.0 ±11.5 versus +3.0 ±10.6 in the IG versus the CG respectively, p<0.0001). The MPR at baseline were very high in both groups (92.9 ±14.6% versus 96.6 ± 15.6% in the IG versus the CG, respectively). There was a trend in a better adherence (+2.2 ±13.9 versus -0.6 ±18.9 in the IG versus the CG in the MPR score respectively, p = 0,691). The disease activity (changes in BASDAI) remained stable during the study in both groups. All the patients were mostly or totally satisfied by the pharmacists’ interview.Conclusion:Pharmacists’ educational interview on subcutaneous bDMARDs is effective in improving the knowledge of patients with SpA on their treatment. Regarding therapeutic adherence, a trend in favor of an improvement was observed in the intervention group but did not reach the statistically significance. Nevertheless, the results observed in this study are an argument to propose to include the pharmacists in the multidisciplinary team in charge of the management of patients with SpA.
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