Objectives To study the adherence to biologic therapy (BT) in patients with RA.
Methods Design :Cross-sectional study. Patients: Consecutive sampling stratified by route of administration in the biological therapy unit (UTB). Protocol: Patients with sc BT are alternately reviewed every 3 months in general and specific (only BT pts) outpatient clinic. Iv BT patients are checked each time the drug is infused. Both groups of pts are reviewed according to a predetermined protocol of data collection. At the start of BT all subjects are interviewed by a nurse who explains the mode of application of drugs and emphasizing the importance of adherence to the effectiveness and safety of BT. Outcome variables: (1) level of adherence evaluated by Morisky-Green Test (MGT) and withdrawal drug in hospital pharmacy or drugstore (medication possession ratio [MPR]). Good adherence was considered when 4 responses indicative of adherence were given in MGT and a MPR>80%. The attendance rate to infusions was handled as equivalent to the medication possession ratio. Other variables: Demographics, comorbidities, clinical-analytical and synthetic DMARDs reclaim in the drugstores using “XXI electronic prescription”(a software used to control the dispensations in the public health system in Andalusia) in the last 6 months. Statistical analysis: Bivariate analyses were performed using T student test, Mann Whitney U test and Ji square test, followed by binary logistic regression (BLR).
Results The main characteristics of the patients (n=178) are shown in the table. One hundred and twelve (63%) were with sc BT, 66 (37%) with iv BT and 49 patients (27.5%) were in monotherapy. 123/178 (69%) showed good adherence to BT and 67/129 (52%) took correctly concomitant synthetic DMARDs. Good adherence to BT was associated in the bivariate analyses with better control of the disease measured by DAS28 (p<0.001) and HAQ (p=0.006), fewer comorbidities (p=0.061), lower multimorbidity (p=0.014) and iv administration.However, in the multivariate analysis of poor adherence to BT as dependent variable identified only moderate to high activity DAS28 (OR [95% CI] = 4.51 [1.78 to 11.38]; p=0.001) and poor adherence to DMARDs (OR [95% CI] = 5.42 [2.18 to 13.24]; p<0.001) as independent predictors.
Conclusions Adherence to BT of patients with RA in a specific unit is moderate (69.1%) and adherence to the concomitant synthetic DMARDs is bad (52.7%).Patients with moderate or high activity in the previous 6 months, have 4.5 odds of having a bad adherence to FAMEb compared to those who are in remission or have low activity. Likewise, patients who do not take in proper manner associated biological DMARDs are 5.4 times more likely to have bad adherence to FAMEb.
Disclosure of Interest None declared
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