The predictors of and reasons for non-adherence in an observational cohort of patients with rheumatoid arthritis commencing methotrexate
| Autor: | James Bluett, Suzanne M M Verstappen, Anne Barton, Rams co-investigators, Kimme L. Hyrich, Lis Cordingley, Holly Hope, Jamie C. Sergeant, J. Anderson |
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| Rok vydání: | 2019 |
| Předmět: |
rheumatoid arthritis
Male medicine.medical_specialty Psychological intervention Logistic regression Severity of Illness Index Medication Adherence Arthritis Rheumatoid Rheumatology Internal medicine medicine Humans Pharmacology (medical) adherence Prospective Studies business.industry Odds ratio Middle Aged Prognosis medicine.disease Comorbidity United Kingdom Methotrexate Treatment Outcome csDMARDs Antirheumatic Agents Rheumatoid arthritis Cohort Female Observational study prrediction models medication beliefs Morbidity business illness beliefs Follow-Up Studies Cohort study |
| Zdroj: | Hope, H, Hyrich, K, Anderson, J, Bluett, J, Sergeant, J, Barton, A, Cordingley, L, Verstappen, S & RAMS Co-Investigators 2019, ' THE PREDICTORS OF AND REASONS FOR NON-ADHERENCE IN AN OBSERVATIONAL COHORT OF PATIENTS WITH RHEUMATOID ARTHRITIS COMMENCING METHOTREXATE ', Rheumatology (Oxford), vol. 59, no. 1, pp. 213-223 . https://doi.org/10.1093/rheumatology/kez274 |
| ISSN: | 1462-0332 1462-0324 |
| DOI: | 10.1093/rheumatology/kez274 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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