Background Biological disease-modifying antirheumatic drug (bDMARD) and tofacitinib are highly effective, but with different pharmaceutical forms, adverse reactions and cost that could affect adherence therapy and drug access.
Objectives To determine patient adherence and administrative access to the treatment with bDMARDs and tofacitnib in patients with rheumatological diseases in Colombia.
Methods A retrospective cohort study, which included all patients in management with bDMARD and tofactinib initiated between July 1, 2015 and June 30, 2016. A monthly follow-up of the administrative adherence were evaluated by holding or applying the medication, as well as the application of Morisky-Green test in self-administered oral and subcutaneous therapies (non-adherent patient was considered when at least one doses is lost), other variables such as sociodemographic, comorbidities, and co-prescriptions were evaluated. A descriptive analysis, χ2 for comparison and multivariate logistic regression were performed.
Results A total of 1102 patients were evaluated, with a mean age of 52.8±15.4 years and a female predominance (72.8%). The most frequent comorbidities were hypertension (22.6%) and dyslipidemia (15.9%). The most prescribed drugs studied were adalimumab (31.9%), etanercept (22.2%) and tofacitinib (12.5%). 52.8% use conventional DMARDs and 42.2% use glucocorticoids. Global adherence was 66.3% as measured by Morisky-Green test. Adherence was better with self-administered subcutaneous drugs every week or longer, compared to daily dosing of oral drug; these data are detailed in table 1. In 42.4% of the patients, at least one delay per year in the application or dispensation occurred, leading to 36.1% of patients experiencing dose losses due to difficulties in access. The main reason (23%) for delays and dose losses is the failures by health-insurance companies to allow timely access to the therapy. In the multivariate analysis treatment with adalimumab or tofacitinib was associated with a greater probability of presenting delays in access after adjustment of variables.
Conclusions Subcutaneous self-applications of bDMARD have better adherence rates compared to oral drug. However, the limitations in access to treatment decrease the adherence. On the other hand the impact of the adherence could be major in the case of self-administered DMARD when weekly or longer intervals doses are lost, compared with the loss of one daily dose of tofacitinib.
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Acknowledgements To Universidad Tecnolόgica de Pereira and Audifarma S.A.
Disclosure of Interest J. Machado-Alba Grant/research support from: The authors declare that Pfizer Colombia financed the data collection process in medical records. There was no intervention in the stages of processing, analysis or publication of that data. No non-financial conflicts of interest exist for any of the authors., M. Machado-Duque: None declared, S. Granada: None declared