Background: Recent years have seen numerous encouraging developments in the treatment of patients with rheumatoid arthritis (RA) with significant improvement in disease control. However, methotrexate (MTX) remains a cornerstone therapy and first-line drug for majority of patients with RA, commonly associated with prolonged or even lifelong treatment, which takes the risk for decreasing medication adherence over time Therefore, prompt recognition of predictive factors for MTX non-adherence is one of the most important challenges related to treatment of patients with RA.
Objectives: The aims of this study were to assess patients’ self-reported adherence to MTX, as well as to investigate predictive role of physician-patient interaction satisfaction for MTX adherence. Namely, it could be hypothesized that patients’ perceptions of multiple specific components of relationship with their physician are associated with patient trust in their physician, which is strongly related to treatment adherence.
Methods: In the period between May 1 and September 15, 2018, 98 consecutive RA patients who were treated in Clinical center of Montenegro and private clinic “Merkur Nera” were enrolled in this multi-centric cross-sectional study. Non-adherence to MTX was defined as ≥1 dose missed against medical advice. Patients field in the questionnaire consisted of MTX-specific queries, including the questions related to therapy-related communication with their physician. Possible interaction of the investigated confounders and their joint effect on the MTX adherence were analyzed using ordered logistic regression analysis. A multivariate logistic regression analysis was performed including all covariates that appeared to be associated with the endpoint in the univariate models (p<0.1). Odds ratio was used to express the strength of the association between independent predictors and MTX non-adherence as a dependent variable.
Results: Study population was predominantly female (87.8%), and the average age was 56.4±12.1 years. The median duration of RA was 8 years (range 0-34 years), while the median duration of MTX treatment was 6 years (range 0-26 years). The median current dose of MTX which responders received was 15 mg per week. The overall prevalence of non-adherence to MTX was 32.7%. According to the results of univariate regression analysis the following factors are significantly associated with adherence to MTX: younger age (OR=0.942; p=0.065), employment (OR=0.956; p=0.095), working capacity (OR=0,342; p=0.057), marital status (OR=0.342; p=0.001) and expressed need for more communication with the doctor regarding RA treatment (OR=1.410; p=0.021). Finally, in the multivariate regression model the following variables remained statistically significant: marital status (OR=0.406; p=0.007) and expressed need for more communication with the doctor related to RA treatment (OR=1.303 p=0.044). Namely, married RA patients were 2.46 times less likely to MTX non-adherence compared to others, while the patients who stated the need for more communication with the doctor regarding RA treatment has 1,30 times greater chances to MTX non-adherence.
Conclusion: The results of our study have shown that about one third of RA patients met the criteria for non-adherence to MTX. Identification of the patient’s need for more communication related to RA therapy as independent predictor for MTX non-adherence suggests that physician-patient relationship quality is an important point of intervention for efforts to improve patients’ medication adherence.
Disclosure of Interests: None declared
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