Background Non-adherence to DMARDs is associated with disease flares and increased disability. Adherence rates to prescribed medicine regimes in people with Rheumatoid Arthritis vary from 30–80% in different studies. Improving adherence to therapy leads to better disease outcome and reduced costs associated with management of RA.
Objectives This study was carried out as a pilot study to look at the effect of co-prescription of steroids on the adherence and side effects to newly prescribed DMARDS in patients with rheumatoid arthritis.
Methods This is a prospective, observational cohort study, for the duration of three months per participant. Patients were selected sequentially from those attending outpatient clinic at Basildon Hospitals with a confirmed diagnosis of rheumatoid arthritis (ACR/EULAR criteria), and had been planned to start on a new DMARD by the treating physician. Baseline data included demographics, disease characteristics and data regarding steroid co- prescription including route, dose and duration. Patients were reviewed at three months to look at DMARD adherence defined by continuation of the DMARD. We looked at the side effect profile as possible contributing factor to non-adherence. The effect of co-prescription with steroids and other demographic data on treatment duration was investigated using Kaplan-Meier survival plots. Logistic regression analysis was used to investigate the effect of co- prescription of steroids on continuation of medication.
Results Fifty one patients were recruited to the study. Median age at the time of enrolment was 61 years (IQR 46–71), 73% were females and 92% were caucasians. seventy percent of the patients were seropositive and DMARD naïve with a mean DAS CRP at recruitment of 4.13 (1.21). Seventeen (33%) patients were co-prescribed with steroids at the initiation of DMARDs. Out of these 59% (n=10) were DMARD naïve. Thirteen patients received a tapering dose of oral prednisolone with a mean starting dose of 13.8mg daily (range 3mg - 20 mg) for a mean duration of 10.8 weeks. Two patients received oral prednisolone 5mg daily for 12 week. The mean cumulative dose of oral prednisolone prescribed was 632.2mg. The two remaining patients received 120 mg of depomedrone IM.
The non adherence rate for our cohort was 35%, 6% for patients co-prescribed with steroids versus 50% for patients who were not co-prescribed with steroids. The odds ratio for likelihood of discontinuation for patients who were not co-prescribed with steroids versus patients who were, was 16 (1.94–134.5, p=0.011).
At the end of three months 25% of the whole cohort, 12% of the patients who were co-prescribed with steroids versus 32% of the patients who were not co-prescribed with steroids reported side effects to the DMARD initiated. the odds ratio for reporting side effects with steroid co-prescription was 0.28 (0.054–1.438, p=0.12).
Conclusions Co-prescription of low dose steroids with initiation of DMARDs increases the chances of adherence and possibly reduces the side-effect profile
van den Bemt BJ, Zwikker HE, van den Ende CH. Medication adherence in patients with rheumatoid arthritis: a critical appraisal of the existing literature. Expert Rev Clin Immunol. 2012;8(4):337–351.
Disclosure of Interest None declared
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