Background Worldwide, methotrexate (MTX) is considered the first-line disease-modifying antirheumatic drug treatment for patients with rheumatoid arthritis (RA). MTX compliance among patients with RA may be influenced by MTX response, adverse events, disease duration/activity, and comorbidities. Better understanding of MTX use, patient and disease characteristics, compliance, and reasons for noncompliance may help identify patients who would benefit from alternative RA treatments and possibly increase compliance.
Objectives To assess self-reported compliance and identify reasons for noncompliance with MTX.
Methods Members of an RA patient panel in the US self-reporting a clinician diagnosis of RA ≥3 months and current MTX use ≥4 weeks, with or without concomitant use of another prescription medication for RA, were recruited for a cross-sectional, Web-based survey.
Results Of 3,849 RA panelists who were screened, 61% confirmed a diagnoses of RA for at least 3 months; of those, 70% were excluded as they did not currently take MTX. Of the 596 (15%) who met all eligibility criteria, 512 consented and a total of 501 completed the questionnaire (251 MTX monotherapy [MONO], 250 MTX combination therapy [COMBO]). The overall sample was predominantly female (62%), white (71%), non-Hispanic (84%), and reported at least some college education (79%); 48% were 18 to 44 years old and 30% were 45 to 54 years old; 47% had other medical comorbidities; 22% had Modified Health Assessment Questionnaire scores <0.3 (no disability); 66% of the sample was first diagnosed with RA within the past 5 years; 51% reported using MTX <1 year and 33% for 1 to 5 years. The majority of patients (83%) reported using oral MTX, and 59% were prescribed to take or inject it once weekly. Forty-two percent of the sample indicated that they did not take their MTX exactly as prescribed during the past 4 weeks. Of the 211 patients who did not always take their MTX exactly as prescribed, 33% reported forgetting to take it, 24% felt they did not need to take it when feeling good, and 24% were concerned about its “long-term safety”. Forgetting to take it was more frequently reported in MTX COMBO patients (40%) than MTX MONO (27%) (p<.05). Additionally, of these 211 patients, 53% took smaller doses than prescribed, 52% skipped doses and 6% reported other ways of taking MTX than prescribed. A logistic regression model was used to identify factors associated with level of MTX compliance (most or all of the time vs. none to some of the time). Specifically, younger age, male, and shorter duration of MTX use were associated with poorer self-reported compliance. Additionally, compared to MTX MONO, MTX COMBO therapy patients, particularly with ≥2 other prescription medications for RA, were less likely to report high compliance [OR (95% CI): 0.46 (0.25,0.85)].
Conclusions Nearly half of patients with MTX reported less than perfect compliance with MTX. Most frequently reported reasons for noncompliance with MTX were forgetting or not remembering to take it, feeling it is not needed when feeling good, and concern about long-term safety. Patients with 2 other prescription medications for RA were less likely to report good compliance, suggesting reducing treatment burden, including use of an effective biologic, may improve patient compliance and further maintain treatment benefit.
Disclosure of Interest D. DiBenedetti Consultant for: Genentech, X. Zhou Consultant for: Genentech, M. Reynolds Consultant for: Genentech, S. Ogale Employee of: Genentech, J. Best Employee of: Genentech