The predictors of and reasons for non-adherence in an observational cohort of patients with rheumatoid arthritis commencing methotrexate

Holly F. Hope*, Kimme L. Hyrich, James Anderson, James Bluett, Jamie C. Sergeant, Anne Barton, Lis Cordingley, Suzanne M.M. Verstappen, Ade Adebajo, Khalid Ahmed, Atheer Al-Ansari, Roshan Amarasena, Marwan Bukhari, Margaret Callan, Easwaradhas G. Chelliah, Hector Chinoy, Annie Cooper, Bhaskar Dasgupta, Martin Davis, James GallowayAndrew Gough, Michael Green, Nicola Gullick, Jennifer Hamilton, Waji Hassan, Samantha Hider, Sanjeet Kamath, Susan Knight, Suzanne Lane, Martin Lee, Sarah Levy, Lizzy MacPhie, Christopher Marguerie, Tarnya Marshall, Catherine Mathews, Frank McKenna, Sophia Naz, Mark Perry, Louise Pollard, Brian Quilty, Lindsay Robertson, Dipak Roy, Paul Sanders, Vadivelu Saravanan, David Scott, Gillian Smith, Richard Smith, Deborah Symmons, Lee Suan Teh, Nick Viner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)213-223
Number of pages11
JournalRheumatology
Volume59
Issue number1
DOIs
Publication statusPublished - 1 Jan 2020

ASJC Scopus subject areas

  • Rheumatology
  • Pharmacology (medical)

Keywords

  • adherence
  • csDMARDs
  • illness beliefs
  • medication beliefs
  • methotrexate
  • prediction models
  • rheumatoid arthritis

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