Background Despite the development of new biologic therapies for the treatment of patients with rheumatoid arthritis (RA), methotrexate (MTX) remains the preferred initial antirheumatic drug1 and one of the most commonly prescribed drugs to treat RA. Available evidence shows that patient adherence to RA medications is suboptimal, with adherence rates ranging from 49.5% to 98.5%.2 Although several different tools have been designed to assess overall medication adherence in RA, none is specific to MTX and adapted for use in routine clinical practice.
Objectives The objective of this work was to develop a new tool to assess adherence specific to MTX. This patient self-administered tool is intended for use in research studies and routine clinical practice to identify nonadherence to MTX and thereby help clinicians make better-informed treatment decisions.
Methods Thirty-two face-to-face interviews were conducted in the United States with RA patients currently or previously treated with MTX to collect information on their experiences with MTX treatment. Interviews were audio-recorded with patient permission, transcribed word for word, and analyzed using ATLAS.ti software. Qualitative analysis of the interview transcripts included sorting quotes based on adherence-related concepts, organizing them into homogeneous domains based on theoretical models of health-related behavior, and creating a conceptual model. A saturation review was conducted to verify that all significant concepts were captured in the patient interviews.
Results The median age of interviewed patients was 57 years, and 68% were female. Of the 32 patients interviewed, 11 were receiving oral MTX, 15 were receiving an injectable form of MTX, and 6 had stopped MTX at the time of the interview. Of the 26 patients treated with MTX, 21 were taking MTX in combination with at least one other form of therapy. The conceptual model resulting from the patient interviews was discussed with clinical experts, and relevant adherence concepts specific to MTX were selected. For each relevant concept, at least one item was generated using words and phrases collected during the patient interviews. A test version of the new adherence tool was developed and included 30 items covering the following domains: practical barriers to MTX (5 items), patient behavior related to MTX (9 items), perceived efficacy of MTX (6 items), perceptual and emotional barriers related to MTX (7 items), and patient opinions about care (3 items).
Conclusions This newly created MTX-specific adherence tool aims to facilitate communication between patients and clinicians during in-office consultations to help clinicians identify patients facing adherence issues with MTX. Before its finalization, the tool will be pilot tested with patients and clinicians for comprehension and relevance, modifications will be made, and a revised version will be created. The pilot version of the tool will be subjected to further assessment and validation to ensure its robustness for use in both research and clinical practice settings.
Smolen JS et al. Ann Rheum Dis. 2010;69:964-975.
Pasma A et al. Semin Arthritis Rheum. 2013;43:18-28.
Disclosure of Interest M. Aassi Employee of: Roche, C. Dias Barbosa Consultant for: Roche, C. Bernasconi Consultant for: Roche, M. Brethous Employee of: Roche, B. Arnould Consultant for: Roche, J. Curtis Grant/research support from: Roche/Genentech, UCB, Janssen, CORRONA, Amgen, Pfizer, BMS, Crescendo, AbbVie, Consultant for: Roche/Genentech, UCB, Janssen, CORRONA, Amgen, Pfizer, BMS, Crescendo, AbbVie