Abstract
Objectives. To investigate levels of self-reported adherence to biologic treatment and establish the contribution of demographic, physical and psychological factors to biologic medication adherence in an RA cohort.Methods. Adalimumab-treated patients were recruited through the British Society for Rheumatology Biologics Register for RA between May 2007 and April 2009. Demographic and baseline psychological measures including illness and medication beliefs were collected. Disease activity (28-item DAS), physical function (HAQ) and quality of life (36-item Short Form Health Survey) were also measured at baseline and at 6, 12 and 18 months. Adherence was assessed at each follow-up using the patient self-completed Compliance Questionnaire for Rheumatology (CQR). Multilevel mixed effects modelling analysis was performed to investigate predictors of adherence.Results. Of the 329 Adalimumab-treated patients included, low adherence (CQR score <65) was reported in 23%, with 41% reporting low adherence at at least one time point. After controlling for age and disease duration, factors independently predictive of increased adherence were increased belief in medication necessity, with baseline effect diminishing over time [β coefficient 1.68 (s.e. 0.19), P = 0.0001], lower medication concerns [0.50 (0.15), P = 0.001], with this effect remaining throughout follow-up, increased professional or family member support [0.81 (0.32), P = 0.01], strong views of illness being chronic [0.32 (0.14), P = 0.025] and increased treatment control [0.41 (0.19), P = 0.032].Conclusion. Wider recognition of the importance of psychological factors, particularly medication beliefs, in driving medication adherence could have substantial clinical and health economic benefits in RA. The psychological factors we have identified are putative targets for strategies to improve adherence in RA.
Highlights
Medication adherence is defined as the extent to which a patient’s behaviour in taking their medication corresponds to agreed recommendations by their health care provider [1]
A quarter of RA patients show only low to moderate adherence to adalimumab
Illness and treatment beliefs are the major influences on adherence to adalimumab among RA patients
Summary
Medication adherence is defined as the extent to which a patient’s behaviour in taking their medication corresponds to agreed recommendations by their health care provider [1]. There is increasing recognition of lower adherence even in symptomatic diseases such as RA with medication adherence rates reported between 55% and 96% [36]. Little is known about biologic drug adherence in RA, and studies are further limited as adherence rates tend to be derived from proxy measures, including medication persistence (time from prescription initiation to prescription discontinuation), drug survival or medication possession ratios from administrative claims data [711]. With the wider use of biologic therapy in RA, together with reported low medication possession ratios and persistence rates suggested in RA in general, there is a clear need to investigate adherence rates of biologic therapy in real-world practice. Biologic therapies have high lifetime costs to the health care system [17], and lower persistence to biologic therapy is associated with higher non-pharmacy costs [18]
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