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FRI0183 Adherence to Methotrexate in Rheumatoid Arthritis Treated by Practice Vs. Hospital Based Rheumatologists: A Danish Nationwide Cohort Study
  1. H. Bliddal1,
  2. S.A. Eriksen2,
  3. R. Christensen2,
  4. T. Lorenzen3,
  5. M.S. Hansen4,
  6. M. Østergaard5,
  7. L. Dreyer6,
  8. P. Vestergaard7
  1. 1The Parker Institute Dept of Rheum
  2. 2The Parker Institute, Dept Rheum, Copenhagen University Hospital Bispebjerg Frederiksberg, Frederiksberg
  3. 3Rheumatology, Silkeborg Hospital, Silkeborg
  4. 4Clinic of Rheumatology, Clinic of Rheumatology, Roskile
  5. 5Rheumatology, Copenhagen University Hospital Glostrup, Glostrup
  6. 6Rehumatology, Copenhagen University Hospital Gentofte, Gentofte
  7. 7Medical, Aalborg University Hospital, Aalborg, Denmark

Abstract

Background Adherence to Methotrexate has been reported to be weak in patients with rheumatoid arthritis.

Objectives To study adherence to methotrexate (MTX) and factors of importance thereof. in rheumatoid arthritis (RA).

Methods Danish Nationwide cohort study. All patients with a hospital diagnosis of RA (ICD10 codes M05.X, M06.X) after January 1, 1997 and aged ≥18 years at the date of first diagnosis/contact, with at least one prescription of MTX (L04AX03) were included. To avoid prevalent cases only those with a first time diagnosis after January 1, 1998 were included.

Results A total of 18,703 patients had ever used MTX among 39,286 with a diagnosis of RA, and among these, 16,503 had filed more than one MTX prescription. Among MTX users, 48% had been exposed to systemic corticosteroids within the last year prior to first MTX prescription. Time from diagnosis to first MTX prescription was 1.6±2.4years with no indication of decrease during the period. In those who filed more than one MTX prescription, the mean persistence time for ≥7.5 mg MTX per week was 4,766 days. The main determinants of non-persistence were female gender, younger age, and time from diagnosis to initiation of MTX (those with more than 1 year of lag time being less compliant). The MTX adherence was the same in patients treated in hospital outpatient clinics or by private practising specialist.

Table 1.

Risk of non-adherence to MTX. Cox proportional Hazard model. Crude and multiply adjusted hazard rates (HR) and 95% confidence intervals (CI)

Conclusions Treatment at hospital or in private practice did not influence the adherence to MTX. Non-modifiable factors of importance were gender and age, while adherence to MTX therapy decreased with a longer time lapse between diagnosis and prescription. The present study could not document a quick and consistent use of MTX early after diagnosis, as the recommended aggressive treat-to-target strategy with MTX as anchor drug would suggest.

Acknowledgements We thank the personal and scientific support of Statistics Denmark.

Disclosure of Interest H. Bliddal Grant/research support: Roche, Pfizer, Abbvie, Novo, S. Eriksen: None declared, R. Christensen Grant/research support: Roche, Pfizer, MSD, UCB, T. Lorenzen Grant/research support: Roche, M. Hansen Grant/research support: Roche, M. Østergaard Grant/research support: Abbott, Bristol-Myers Squibb, Centocor, GlaxoSmithKline, Janssen, Merck, Mundipharma, Novo Nordisk, Pfizer, Schering-Plough, Roche UCB, L. Dreyer: None declared, P. Vestergaard: None declared

DOI 10.1136/annrheumdis-2014-eular.5585

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