Background Adherence to medication depends on several factors such as medication beliefs, psychosocial factors, illness beliefs and concerns. The consequences of non-adherence are not insignificant, both from the clinical and health economic aspects.
Objectives To assess medication adherence of patients taking biologics who are in remission or who have low disease activity and patients' perception of disease progression.
Methods Forty-four consecutive patients attending a dedicated biologic clinic and treated with TNF inhibitors were interviewed following their visit. Patients were asked about adherence to treatment, adverse effects, concerns about biologics and their perception of disease progression. Demographic and disease activity data were recorded.
Results Forty-four patients (23 females, 21 males) participated in the survey (21 suffered from rheumatoid arthritis, 17 from ankylosing spondylitis and 6 from psoriatic arthritis). The mean age was 55.1 (SD 12.62) years. The mean DAS28 was 2.26 (SD 1.03) and the mean BASDAI was 4.21 (SD 2.1). Minimal or no pain was reported by 75%, mild or no fatigue by 78% and 77% had no restriction of activities of daily living. Medication adherence was reported as high by 68% and moderate by 32%. There were no patients who had a low level of adherence. 5% of patients admitted to be unaware of the need to omit their biologic when ill and 40% when requiring surgery.
One out of 4 patients reported to have experienced adverse events, most commonly infections. 19% claimed to be moderately or very concerned about the adverse effects. On further questioning about the severity of potential adverse effects, 45% were unsure as to what the severity might be. When asked about duration of therapy, 29% replied more than 10 years; whilst 71% were unsure on when, if ever, the biologic is going to be stopped. Patients were also asked whether they believed that the biologic had successfully stopped further joint damage and 68% replied yes, 9% replied no, whilst 23% were unsure. Of those who replied yes, this perception was based on the absence or reduction of symptoms.
Conclusions In this cohort of patients with low disease activity or remission, a third of patients still reported sub-optimal adherence to TNF inhibitor use. The benefits of adherence to biologic therapies need to be reinforced at every visit and factors leading to non-adherence addressed. Adverse effects remain a major concern that needs to be addressed, even in patients who have been on biologics for many years and have sustained remission or low disease activity. A quarter of patients were unsure whether biologics have stopped joint damage. Patients' perception of joint damage progression needs to be explored to find ways of making it more understandable to patients.
Disclosure of Interest None declared