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Background: Medication non-adherence has been associated with treatment failure in chronic inflammatory conditions. A positive relationship between patient activation and adherence to treatment and between activation and improved clinical outcomes has been shown for chronic conditions. Objectives: To measure adherence to biological therapies and targeted synthetic DMARD (tsDMARD), and their relationship with the Patient Activation Measure (PAM) and with patient and therapy related factors, for chronic inflammatory arthropathies. Methods: Cross-sectional observational descriptive study in a general tertiary university hospital. Patients on treatment with the same biological drug (subcutaneous; phase 1) or tsDMARD (oral; phase 2) for ≥6 months were included in order of arrival and those with mental disability, which prevented understanding of the study, were excluded. Demographic variables (sex, age, living environment, educational level), diagnosis and treatment were collected. Adherence was measured using the Simplified Medication Adherence Questionnaire (SMAQ) for biological therapies, the Compliance Questionnaire Rheumatology (CQR-19) for tsDMARD, and the medication possession ratio (MPR). Patients were considered adherent if MPR≥80% and CQR-19≥80% or adherent SMAQ. To measure activation, PAM questionnaire, was used. Patients were classified as activated or not activated. Statistical analysis: relationship between adherence to treatment and PAM was analyzed using chi-square, considering significance level p Results: A total of 58 patients (57% women) were included. Mean age was 54 years (95% CI: 50 to 57), 86% lived in urban areas, 40% had completed elementary education, 31% high-school and 24% university studies. Distribution by diagnosis: rheumatoid arthritis (81%), ankylosing spondylitis (14%) and psoriatic arthritis (5%). Distribution by treatment was: baricitinib (31%), tofacitinib (18%), adalimumab (16%), tocilizumab (14%), etanercept (12%), secukinumab (7%) and golimumab (3%). Median time of disease duration was 9 years (IQR 13) and time on treatment with the drug was 8 months (IQR 20), with significant differences between groups (27 (biological therapy) vs 7 months (tsDMARD)). The proportion of adherent patients was 43%, being higher among tsDMARD (57%) vs biological treated ones (30%), with significant differences. 72% of patients were activated, being more activated biological (80%) than tsDMARD (67%) treated patients. A higher adherent proportion of patients was found among the activated patients (48%) compared to the non-activated ones (27%) in all measures, even though the differences were not statistically significant. Conclusion: Patients treated with biological therapies and tsDMARD have a high degree of activation for the self-management of their disease and its treatment. Adherence to treatment may be influenced by route of administration, type of drug (oral/tsDMARD 57% vs. subcutaneous/biological 30%) and time on treatment (longer time on treatment, lesser adherence). The greater proportion of adherence found among patients with a higher degree of activation could indicate a positive relationship between activation and adherence, so analyzing and promoting patient activation seems important in order to improve adherence to drugs. Disclosure of Interests: None declared |
