Background Adherence is a critical factor in the therapeutic response in rheumatoid arthritis (RA), which may be influenced by the doctor-patient relationship. In the ARCO study, we previously reported a percentage of lack of adherence to the subcutaneous biologic of 14.3% during the first 14 months of treatment, and that the adherence was better in patients without induction and with a monthly administration schedule.¹ In this post hoc analysis, we explored whether doctor-patient disagreements may be related to lower adherence rates.

Objectives To analyse the percentage of patients with discrepancies in the evaluation of the activity of the disease between doctors and patients and a possible association between the existence of disagreement and adherence to subcutaneous biological drugs.

Methods The ARCO study was a multicenter, cross-sectional study in which patients with RA were included according to EULAR-ACR 2010 criteria, who had been prescribed a subcutaneous biological drug in the previous 12–18 months. As part of the evaluation of the disease, patients and doctors were asked to rate the disease on a visual analogue scale (VAS), with values ranging from 0 to 10; with higher values indicating worst symptoms. Disagreement was defined as a difference of >/=3 points between the absolute values. Adherence was assessed retrospectively by means of the Medication Posession Ratio (MPR), considering adherence those patients with MPR >80%. The association between adherence and disagreement was studied using bi and multivariate logistic regression models with covariates-adjustments.

Results We included 360 patients (77.5% women, mean age: 55±0.6 years). Disagreement was detected in 56 (15.5%). In patients with disagreement, the mean VAS score of the patient was 5.75±1.8 versus 2.7±2.2 in the group without disagreement (p<0.001), and there were no differences in terms of the doctors VAS (group with disagreement=2.7±1.8 versus 2.2±2.0 in the group without disagreement, p=0.110). The two groups of patients presented differences in terms of age (5 years more than average in the group with disagreement, p=0.010), presence of comorbidity (14% more frequent in the group with disagreement, p=0.030) and the value of the mean DAS28 (0.6 points higher in the group with disagreement, p<0.001). Among the patients who presented a VAS disagreement, the percentage of non-adherence was 10.7%, and of 14.5% among those who had a VAS similar to the doctor (p=0.45). The regression analysis showed no difference in the association between adherence and disagreement; by introducing into the models covariates associated with adherence (induction, frequency of administration and age) or with disagreement (age, comorbidity and DAS28).

Conclusions We observed a disagreement between patients and doctor VAS scores in 15.5% of cases, with higher values coming from patients. We did not observed an association between this disagreement and adherence to subcutaneous biological drugs.

Reference [1] Calvo-Alen J, Monteagudo I, Salvador G, Vazquez-Rodriguez TR, Tovar-Beltran JV, Vela P, et al. Non-adherence to subcutaneous biological medication in patients with rheumatoid arthritis: a multicentre, non-interventional study. Clin Exp Rheumatol2017;35(3):423–30.

Acknowledgements This is a secondary analysis of the ARCO study, which was financed by Merck Sharp and Dohme Spain.

Disclosure of Interest T. Oton: None declared, J. Calvo-Alén : None declared, L. Cea-Calvo Employee of: Merck Sharp and Dohme S.A, L. Carmona: None declared