The predictors of and reasons for non-adherence in an observational cohort of patients with rheumatoid arthritis commencing methotrexate
Author:
Hope Holly F12, Hyrich Kimme L23, Anderson James4, Bluett James24, Sergeant Jamie C35ORCID, Barton Anne14, Cordingley Lis23, Verstappen Suzanne M M23, Adebajo Ade, Ahmed Khalid, Al-Ansari Atheer, Amarasena Roshan, Bukhari Marwan, Callan Margaret, Chelliah Easwaradhas G, Chinoy Hector, Cooper Annie, Dasgupta Bhaskar, Davis Martin, Galloway James, Gough Andrew, Green Michael, Gullick Nicola, Hamilton Jennifer, Hassan Waji, Hider Samantha, Hyrich Kimme, Kamath Sanjeet, Knight Susan, Lane Suzanne, Lee Martin, Levy Sarah, Macphie Lizzy, Marguerie Christopher, Marshall Tarnya, Mathews Catherine, McKenna Frank, Naz Sophia, Perry Mark, Pollard Louise, Quilty Brian, Robertson Lindsay, Roy Dipak, Sanders Paul, Saravanan Vadivelu, Scott David, Smith Gillian, Smith Richard, Symmons Deborah, Teh Lee-Suan, Viner Nick,
Affiliation:
1. Centre for Women’s Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK 2. NIHR Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK 3. Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK 4. Arthritis Research UK Centre for Genetics and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK 5. Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
Abstract
Abstract
Objective
In order to develop interventions to optimize MTX use for the treatment of RA we evaluated the rate of, reasons for and predictors of MTX non-adherence during the first 6 months of therapy.
Methods
The Rheumatoid Arthritis Medication Study (RAMS) is a prospective multicentre cohort study of incident MTX users in the UK. Prior to MTX commencement demographic, clinical and psychological data were collected. A weekly patient-completed diary recorded MTX dose, possible side effects and adherence over 26 weeks. The number of non-adherent weeks was calculated. Potential baseline predictors of ever non-adherence (⩾1 week non-adherent) during the first 6 months of MTX therapy were identified using logistic regression analyses.
Results
606 patients with RA were included; 69% female, mean (s.d.) age 60 (13) years and DAS28 score 4.2 (1.2). Over the first 6 months following MTX initiation, 158 (26%) patients were ever non-adherent (71% intentional, 19% non-intentional, 10% unexplained) and mean (s.d.) number of non-adherent weeks was 2.5 (2.1). Multivariable predictors of ever non-adherence included DAS28 [odds ratios (OR) 1.1, 95% CI 1.0, 1.4], fatigue (OR 1.1, 95% CI 1.0, 1.2 per cm), ⩾2 comorbidities vs no comorbidities (OR 1.9, 95% CI 1.1, 3.5) and high medication concerns despite perceived need (OR 1.1, 95% CI 1.0, 1.1 per unit decrease in need/concern differential).
Conclusion
This is the largest study evaluating early intentional and non-intentional non-adherence to MTX, which has identified that patient beliefs and multi-morbidity strongly link with non-adherence. These findings can direct the design of and provide potential targets for interventions to improve patient adherence.
Funder
The National Institute of Health Research Manchester Biomedical Research Centre and Arthritis Research UK
Publisher
Oxford University Press (OUP)
Subject
Pharmacology (medical),Rheumatology
Cited by
40 articles.
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