Background Adherence to treatment is the observance, by patients, of their doctors' recommendations concerning their therapeutic management. There is no gold standard for the measurement of adherence to treatment, but validated self-administered questionnaires can be used to measure adherence indirectly. Few studies have evaluated the prevalence of adherence to all treatment (corticosteroid treatment, DMARDs and biological treatments) in patients with chronic inflammatory rheumatism.
Objectives The aims of our study were to evaluate the prevalence of non-adherence to treatments in patients followed for rheumatoid arthritis (RA), spondylitis (SA) and psoriatic rheumatism (PsA), to identify the socioprofessional and demographic factors associated with non-adherence and to evaluate possible correlations between non-compliance and negative views concerning drugs doctors or medicine, or negative perceptions of the disease and of health in general.
Methods We carried out a prospective study, between January and June 2014, of all patients followed at the hospital for chronic inflammatory rheumatism and treated with corticosteroids, DMARs and/or biotherapy. The patients completed a validated French-language questionnaire concerning their adherence to treatment and including the Morisky-Green adhesion scale (MMAS-4), with its visual analog scale (VAS), opinions about drugs (18-item BMQ), both specifically and in general, for each immunosuppressant used, together with questionnaires concerning the patients' perception of their disease (BIPQ) and of their health in general (PHQ-2). Global non-adherence to treatment was defined as a negative response to one of the four questions of the MMAS-4 and/or a score on the Morisky VAS below 80%. Patients with a Morismy VAS score of 100% were also analyzed in uni- and multivariate analyses. Socioprofessional and demographic data were collected.
Results In total, 109 complete questionnaires were obtained. The mean age of the respondents was 54 years; 58 patients were treated for RA, 41 for SA and eight for PsA; Overall, 39% of the patients were treated by monotherapy, 42% by bitherapy and 19% by tritherapy; 40% received corticosteroids, and 51% had at least one DMARD, 89% of these patients being treated with methotrexate. Biotherapies were prescribed for 89% of the patients, by subcutaneous injection in 25%, and by intravenous injection in 75%. The mean duration of treatment was 10 years. We found that 27 patients (24.7%) were globally non-adherent to corticosteroid, DMARD and biotherapy treatments.17 patients with RA and nine with SA. In univariate and multivariate analyses of patients with a VAS score of at least 80, no factors significantly associated with a lack of adherence were identified. By contrast, considering only patients with VAS scores of 100%, in univariate analysis, the duration of treatment (OR=0.95 [0.91-1], p=0.04), and treatment with DMARDs were found to be associated with poor adherence (OR=0.38 [0.15-0.9], p=0.03). In multivariate analysis, only DMARD treatment was associated with poor adherence (OR=0.25 [0.07-0.74], p=0.017). No significant differences were observed for adherence with biotherapy alone or for global adherence to treatment.
Conclusions In this study, less than one third of the patients followed in a hospital environment were non-adherent, and poor adherence seemed to be linked to the duration of treatment and the use of DMARDs.
Disclosure of Interest None declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.