Background In patients with rheumatoid arthritis (RA), we previously described that adherence to the subcutaneous (SC) biological treatment is better with monthly administration.
Objectives We further assessed if there are differences in patients expectations and satisfaction with efficacy and tolerance that could contribute to explain such finding.
Methods ARCO was a retrospective study on RA patients who had been prescribed a SC biological 11–18 months prior to the study. Adherence was calculated with the medication possession ratio (MPR). Satisfaction and expectations were assessed with the Spanish validated Carbonell questionnaire .
Results We included 364 patients (age 54.9 years [SD 12.5], 77.5% women, median duration of RA 7.8 years, period studied for the SC biological 14.8 months). Non-adherence (MPR ≤80%) was lower in patients with monthly (6.4%) than with weekly (17.4%, p=0.034) or every 2 weeks administration (14.4%, p=0.102). The % of satisfied patients (quite/very satisfied) was 86.2% for efficacy and 64.4% for side effects or tolerance. Non-adherence was similar in satisfied with efficacy and in neutral/unsatisfied patients (14.7% vs. 8.3%, p=0.399), or in patients satisfied/not satisfied with side effects (13.1% vs. 15.4%, p=0.504). The fulfillment of expectations is shown in the table. With regard to expectations on the effect, non-adherence was 15.5% (higher than expected), 12.6% (as expected) and 10.7% (lower than expected) (p=0.677), and with regard to discomfort/side effects, it was 15.6% (greater than expected), 18.5% (as expected) and 11.1% (lower than expected, or no side effect) (p=0.189). Fulfilment of expectation on efficacy was similar for the 3 dosing schemes, but the % reporting lower than expected discomfort or no discomfort was greater with fewer SC injections (table). In particular, the % reporting no discomfort/side effects with the administration were 17.8% (weekly), 29.3% (every 2 weeks), and 35.0% (monthly) (p=0.013).
Conclusions RA patients on SC biological therapy show high satisfaction and fulfillment of expectations on efficacy, although both aspects lower for tolerance. Dosing regimen with lower number of SC injections seems to be associated with better fulfillment of expectations of tolerance. This finding, added to the lower number of injections itself, might explain the better adherence observed with monthly administration.
Carbonell J, Badia X; Grupo Expresar. Development and validation of a satisfaction questionnaire in patients with rheumatoid arthritis. Reumatol Clin 2006;2:137–45.
Acknowledgements Funded by MSD, Spain.
Disclosure of Interest None declared