Background Disease modifying drugs (DMARD) in Rheumatoid Arthritis (RA) reduce the activity of the disease, decrease radiographic progression and improve long term functional outcome as long as patients are adherent to treatment. In chronic conditions 20 to 50% of patients do not take their medications as prescribed. Methotrexate (MTX) is within DMARDs the most widely used drug because of its efficacy and tolerability. RA patients receiving concomitant biological therapy and MTX improve clinical and radiological response. DMARDs non-adherence range from 18 to 42%. In order to improve intervention targets, adherence surveys are practical tools.
Objectives To assess the compliance and identify the causes of MTX suspension in Colombian patients with RA receiving biological therapy.
Methods We reviewed CAYRE medical center RA database. Those who were receiving biologic therapy from February 8 to September 30, 2012 were identified. Data was obtained through telephone survey conducted by a trained nurse. A physician compared patient answers with rheumatologist prescriptions. Statistical analysis including Cohen's kappa coefficient were achieved.
Results 946 RA patients were in biologic therapy, of these 872 (92%) were surveyed. 724 (83%) were women with a mean disease duration of 13.6 years. 463 (53%) patients were receiving oral MTX, 284 (61%) at doses of 15 mg/week or more (maximum 35mg/week). According to the survey 384 (44%) patients discontinued MTX at 4.2 years. The main reasons for discontinuation of MTX were: skin or appendages lesions (31%), diarrhea (18%), and suspended by physician instruction (9.4%). There was a moderate correlation between MTX dose intake according to the survey and prescribed doseaccording to medical records. Kappa =0.5996 (95% CI 0.5440 to 0.6553).
Conclusions We found a 68% compliance with MTX in RA patients receiving biological therapy. This is consistent with observational studies reporting percentage of patients discontinuing MTX. It is important to develop strategies in our center in order to improve compliance and adherence to MTX in RA patients receiving biological therapy. A second phase study will evaluate the effectiveness of these actions.
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deThurah A, Nørgaard M, Johansen MB, Stentgaard-Pedersen K. Methotrexate compliance among patients with rheumatoid arthritis: the influence of disease activity, disease duration, and co-morbidity in a 10-year longitudinal study. Scand J Rheumatol 2010; 39: 197-205.
Disclosure of Interest E. Jáuregui Consultant for: Pfizer, Speakers bureau: Pfizer, Roche, BIOPAS, Abbvie, G. Marianella: None declared, D. Aura: None declared, E. Beltrán: None declared, Y. Muñoz: None declared
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