Background Nonadherence to treatment in rheumatoid arthritis (RA) has been shown to negatively impact on treat to target goals and disease outcomes. Identifying and targeting potential factors influencing nonadherence is therefore crucial in optimising patient management.
Objectives To determine factors associated with nonadherence in patients with RA.
Methods An electronic search was performed by two independent reviewers using MEDLINE and focusing on articles published from inception to January 2017. The search strategy combined the thesaurus (MeSH) and expanded keyword searches of two concepts: RA and treatment adherence. Inclusion criteria included observational studies and clinical trials examining potential factors associated with nonadherence. Exclusion criteria included articles not in English or without online access and those with a focus on forms of therapy other than medication. Agreement between raters at the screening stage was high (97%, kappa=.87).
Results The primary search yielded 1411 papers, from which 75 were eventually identified as suitable for full review (Figure). Of the 75 papers, 65 were based on observational studies and 10 on clinical trials. Factors associated with nonadherence were broadly categorized into patient-related factors (socio-demographic factors, patient perceptions [beliefs/knowledge/attitudes]), disease-related factors (disease duration/severity, comorbidities, functional disability) and treatment-related factors (drug type/ method of administration/duration/regimen complexity, combination therapy). The majority (70% of all included studies) of studies reported significant associations between patient-driven factors and nonadherence. Adherence was found to be negatively associated with socioeconomic status, health literacy, and beliefs/perceptions/knowledge of the disease and treatment. Studies reported poorer mental health state (n=6) and greater disability/pain (n=7) to be implicated in nonadherence. Disease duration was largely non-significant in treatment adherence, although a few studies reported a negative correlation (n=3). Combining biologics with DMARDs was associated with improved adherence. However, considering non-biologic DMARDs only, adherence rates were higher amongst monotherapy users. One study identified polypharmacy to be negatively associated with adherence. Drug side effects were associated with nonadherence (n=7).
Conclusions Patient-related factors including personal perceptions were among key contributors to nonadherence to medication in RA patients. This highlights the need for addressing patient-driven perceptions, along with disease and treatment
Acknowledgements Many thanks to Simon Coates and Julia Garthwaite of Library Services at University College London for their advice.
Disclosure of Interest None declared