Background Adherence to systemic medication may vary between patients (pts) from different geographic areas.
Objectives To explore differences in self-reported adherence and attitudes to systemic medications in different geographical regions, and identify factors associated with high adherence in pts with rheumatoid arthritis (RA) from the ALIGN study.
Methods ALIGN was a global, cross-sectional, non-interventional study in adult pts with 6 inflammatory diseases, including RA. Clinical data were collected and validated pt questionnaires, including 4-item Morisky Medication Adherence Scale (© MMAS-4) and Beliefs About Medicines Questionnaire (BMQ), were administered at a routine visit. Results were compared between the following regions: West, including 16 countries from Western Europe, Canada, Australia and New Zealand; Eastern Europe (EE), including 6 countries; Middle East (ME), including Saudi Arabia and Lebanon; Latin America (LA), including 4 countries; Asia, including Korea and Taiwan. Associations between various factors, including geographic location, and medication adherence were assessed by multiple regression analysis.
Results Data from 1943 pts [West, 1011 pts; EE, 322 pts; ME, 109 pts; LA, 367 pts; Asia, 134 pts; overall mean±SD age: 54.8±13.5 years (y); mean±SD disease duration, 9.2 ± 8.8 y] were analysed. 38.3–51.7% of pts had completely responded to current RA treatment. Duration of current treatment was longest in West region pts and shortest in Asian pts (6.1±5.6 y vs 2.3±2.0 y, P<.0001). Significantly more pts in the West region were highly adherent to their medication vs pts in other regions, with the fewest fully adherent pts in Asia and LA (Table). In general, similar observations were made across various treatment groups (Table). Depending on region, 17–60% of pts reported ever forgetting to take their RA medication; 24.6% of LA pts admitted having problems remembering to take their medication (Table). All groups had similar treatment necessity scores; however, Asian pts reported significantly lower necessity scores, but higher treatment concerns vs pts in all other regions (all P<.05). West region pts reported significantly lower concerns scores vs pts in other regions except EE pts (Table). In multiple regression analysis, higher treatment necessity beliefs were associated with higher medication adherence, and higher treatment concerns with less adherence.
Conclusions There were more RA pts reporting high medication adherence in the West vs other regions, with the fewest in LA and Asia. Asian pts may be less adherent to RA medication due to higher concerns and lower necessity beliefs towards systemic medication. Reasons for the low adherence rate in LA pts need to be explored further.
Acknowledgement AbbVie: Study sponsor, design, data collection, analysis, interpretation; writing, review, approval of abstract. Medical writing: Naina Barretto of AbbVie. Permission for MMAS: Donald Morisky, UCLA. Study contribution: Nicole Selenko-Gebauer and Fabrice Gillas, both of AbbVie
Disclosure of Interest J. Smolen Grant/research support from: AbbVie, D. Gladman Grant/research support from: AbbVie, Amgen, BMS, Celgene, Janssen, Pfizer, Novartis, UCB, H. McNeil: None declared, J. Weinman Consultant for: AbbVie, Employee of: Atlantis Healthcare, Speakers bureau: AbbVie, S. Park: None declared, J. Sommer Employee of: GKM Gesellschaft für Therapieforschung mbH, P. Nurwakagari Shareholder of: AbbVie, Employee of: AbbVie