DOI: http://dx.doi.org/10.18203/2349-3933.ijam20202066

Adherence to methotrexate therapy among rheumatoid arthritis patients in Eastern India

Dibyendu Mukherjee, Suman Naiya, Suvajit Chakraborty, Rahul D. Chakrabarty, Sucharita Patra

Abstract


Background: This study aims to identify adherence rate of methotrexate (MTX) therapy in rheumatoid arthritis (RA) patients of Eastern India and recognize factors contributing to treatment adherence in those patients.

Methods: In this cross-sectional observational study, a total of 140 patients (17 males, 123 females; mean age 37.6±7.4 years) with pre-diagnosed RA attending the rheumatology outpatients clinic between February 2019 and January 2020 fulfilling the inclusion and exclusion criteria, were included. The patients were evaluated in terms of sociodemographic factors, clinical and medication details, disease activity score (DAS28-CRP) values and patient - doctor considerations that might contribute to treatment adherence. They filled out a series of standardised present questionnaires including the Morisky 8-item Medication Adherence Scale (MMAS-8). Data was analysed statistically and compounded.

Results: Of the patients, 29 (20.7%) were adherent and 111 (79.3%) were non-adherent to medication with MTX. 65% were on MTX monotherapy and 35% on polytherapy with csDMARDs. 45.7% of the non-adherent forgot taking medication, 50.7% skipped during travel, 79.3% intentionally did not comply with strict regimen. The DAS28-CRP scores were much higher amongst non-adherent group and fewer reached remission as compared to adherent participants. Commonest reason for non-adherence being adverse drug reaction and financial constraints. Conclusions: This study showed a significantly higher adherence to MTX treatment compared to most previous studies. Adverse drug reactions, financial constraints, complex treatment regimen, long treatment duration, and frequent travel history significantly affect medication adherence in this patient population. Higher the adherence better the treatment response.


Keywords


Adverse drug reactions, Conventional synthetic disease modifying anti-rheumatic drugs, Medication adherence, Rheumatoid arthritis

Full Text:

PDF

References


Osterberg L, Blaschke T. Adherence to medication. New Engl J Medi. 2005 Aug 4;353(5):487-97.

de Klerk E, van der Heijde D, Landewé R, van der Tempel H, Urquhart J, van der Linden S. Patient compliance in rheumatoid arthritis, polymyalgia rheumatica, and gout. J Rheumatol. 2003 Jan 1;30(1):44-54.

Tanaka E, Mannalithara A, Inoue E, Hara M, Tomatsu T, Kamatani N, et al. Efficient management of rheumatoid arthritis significantly reduces long-term functional disability. Ann Rheumat Dis. 2008 Aug 1;67(8):1153-8.

Contreras-Yáñez I, Cabiedes J, Rull-Gabayet M, Pascual-Ramos V, De León SP. Inadequate therapy behavior is associated to disease flares in patients with rheumatoid arthritis who have achieved remission with disease-modifying antirheumatic drugs. Am J Medi Sci. 2010 Oct 1;340(4):282-90.

Pascual-Ramos V, Contreras-Yáñez I, Villa AR, Cabiedes J, Rull-Gabayet M. Medication persistence over 2 years of follow-up in a cohort of early rheumatoid arthritis patients: associated factors and relationship with disease activity and with disability. Arthr Res Ther. 2009 Feb 1;11(1):R26.

Smolen JS, Landewé R, Breedveld FC, Buch M, Burmester G, Dougados M, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheumat Dis. 2014;73(3):492-509.

Brus HL, Van De Laar MA, Taal E, Rasker JJ, Wiegman O. Effects of patient education on compliance with basic treatment regimens and health in recent onset active rheumatoid arthritis. Anna Rheum Dis. 1998 Mar 1;57(3):146-51.

Singh JA, Saag KG, Bridges Jr SL, Akl EA, Bannuru RR, Sullivan MC, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthr Rheumatol. 2016 Jan;68(1):1-26.

Smolen JS, Landewé R, Bijlsma J, Burmester G, Chatzidionysiou K, Dougados M, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017 Jun 1;76(6):960-77.

Smolen JS, Breedveld FC, Burmester GR, Bykerk V, Dougados M, Emery P, et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis. 2016 Jan 1;75(1):3-15.

Gadallah MA, Boulos DN, Dewedar S, Gebrel A, Morisky DE. Assessment of rheumatoid arthritis patients’ adherence to treatment. Am J Medi Scie. 2015 Feb 1;349(2):151-6.

Vrijens B, De Geest S, Hughes DA, Przemyslaw K, Demonceau J, Ruppar T, et al. A new taxonomy for describing and defining adherence to medications. Br J Clini Pharmacol. 2012 May;73(5):691-705.

Lavsa SM, Holzworth A, Ansani NT. Selection of a validated scale for measuring medication adherence. J Am Pharmac Assoc. 2011 Jan 1;51(1):90-4.

Morisky DE, Ang A, Krousel‐Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clini Hypert. 2008 May;10(5):348-54.

WHO. Adherence to Long-term Therapies-Evidence for Action. 2003. Available at: http://www.who.int/chp/knowledge/publications/adherence_ report/en/. Accessed April, 2020.

Park DC, Hertzog C, Leventhal H, Morrell RW, Leventhal E, Birchmore D, et al. Medication adherence in rheumatoid arthritis patients: older is wiser. J Am Geriatr Soc. 1999 Feb;47(2):172-83.

Cramer J. Identifying and improving compliance patterns. Patient Compli Medi Pract Clini Trials. 1991:387-92.

Golin CE, Liu H, Hays RD, Miller LG, Beck CK, Ickovics J, et al. A prospective study of predictors of adherence to combination antiretroviral medication. J Gen Int Medi. 2002;17(10):756-65.

Ickovics JR, Meade CS. Adherence to HAART among patients with HIV: breakthroughs and barriers. AIDS Care. 2002 Jun 1;14(3):309-18.

Bliddal H, Eriksen SA, Christensen R, Lorenzen T, Hansen MS, Østergaard M, et al. Adherence to methotrexate in rheumatoid arthritis: a Danish nationwide cohort study. Arthritis. 2015;2015.

DiBenedetti DB, Zhou X, Reynolds M, Ogale S, Best JH. Assessing Methotrexate Adherence in Rheumatoid Arthritis: A Cross-Sectional Survey. Rheumatol Ther. 2015;2(1):73-84.

Brown MT, Bussell JK. Medication adherence: WHO cares?. Mayo Clin Proceed. 2011 Apr 1;86(4):304-14.

Marshall GN, Hays RD. The patient satisfaction questionnaire short-form (PSQ-18). April 21, 2020.

Wong JB, Ramey DR, Singh G. Long-term morbidity, mortality, and economics of rheumatoid arthritis. Arthr Rheum. 2001;44(12):2746-49

Mittal N, Mittal R, Sharma A, Jose V, Wanchu A, Singh S. Treatment failure with disease-modifying antirheumatic drugs in rheumatoid arthritis patients. Singapore Medi J. 2012 Aug 1;53(8):532-6.

Arshad N, Ahmad NM, Saeed MA, Khan S, Batool S, Farman S. Adherence to Methotrexate therapy in Rheumatoid Arthritis. Pak J Med Sci. 2016;32(2):413-7.

Mohsen AG, Dina NKB, Asmaa G, Sahar D, Donald EM. Assessment of Rheumatoid Arthritis Patients’ Adherence to Treatment. Am J Med Sci. 2015;349(2)151-6.

Qoul KZ, Thuheerat IN, Al-Dogham I. Assessment of medication adherence in rheumatoid arthritis patients. JJ Appl Sci. 2008;10:79-86.

van den Hoogen FH, Benraad B, Hekster YA, van Lankveld WI. Adherence rates and associations with nonadherence in patients with rheumatoid arthritis using disease modifying antirheumatic drugs. J Rheumatol. 2009 Oct 1;36(10):2164-70.

de Thurah A, Nørgaard M, Harder I, Stengaard-Pedersen K. Compliance with methotrexate treatment in patients with rheumatoid arthritis: influence of patients’ beliefs about the medicine. A prospective cohort study. Rheumatol Int. 2010 Sep 1;30(11):1441-8.

Horne R, Weinman J, Barber N. Concordance, Adherence and Compliance in Medicine Taking: A Conceptual Map and Research Prior- ities. London, England: National Co- coordinating Center for NHS Service Delivery and Organization; 2005. Available at: http://www.nets.nihr.ac. uk/__data/assets/pdf_file/0009/64494/FR-08-1412-076.pdf. Accessed April, 2020.

Batko B. Nonadherence and ineffective methotrexate treatment of inflammatory arthritis. Wiadomosci Lekarskie. 2017;70(4):812-9.