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Convertino, Irma, Sabrina Giometto, Rosa Gini, Massimiliano Cazzato, Marco Fornili, Giulia Valdiserra, Emiliano Cappello, et al. "Trajectories of Adherence to Biologic Disease-Modifying Anti-Rheumatic Drugs in Tuscan Administrative Databases: The Pathfinder Study." Journal of Clinical Medicine 10, no. 24 (December 8, 2021): 5743. http://dx.doi.org/10.3390/jcm10245743.
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Scanty information on clustering longitudinal real-world data is available in the medical literature about the adherence implementation phase in rheumatoid arthritis (RA). To identify and characterize trajectories by analyzing the implementation phase of adherence to biologic Disease-Modifying Anti-Rheumatic Drugs (DMARDs), we conducted a retrospective cohort drug-utilization study using Tuscan administrative databases. RA patients were identified by a validated algorithm, including the first biologic DMARD supply from 2010 to 2015, RA specialist visit in the year before or after the first supply date and RA diagnosis in the five years before or in the year after the first supply date. We observed users for three years or until death, neoplasia, or pregnancy. We evaluated adherence quarterly through the Medication Possession Ratio. Firstly, we identified adherence trajectories and described the baseline characteristics; then, we focused on the trajectory most populated to distinguish the related sub-trajectories. We identified 952 first ever-biologic DMARD users in RA (712 females, mean age 52.7 years old, standard deviation 18.8). The biologic DMARD mostly supplied was etanercept (387 users) followed by adalimumab (233). Among 935 users with at least 3 adherence values, we identified 49 fully-adherent users, 829 continuous users, and 57 early-discontinuing users. Significant differences were observed among the index drugs. After focusing on the continuous users, three sub-trajectories were identified: continuous-steady users (556), continuous-alternate users (207), and continuous-declining users (66). No relevant differences emerged at the baseline. The majority of first ever-biologic DMARD users showed a continuous adherence behavior in RA. The role of adherence potential predictors and the association with effectiveness and safety outcomes should be explored by further studies.
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McCulley, Caroline, Patricia Katz, Laura Trupin, Edward H. Yelin, and Jennifer L. Barton. "Association of Medication Beliefs, Self-efficacy, and Adherence in a Diverse Cohort of Adults with Rheumatoid Arthritis." Journal of Rheumatology 45, no. 12 (September 15, 2018): 1636–42. http://dx.doi.org/10.3899/jrheum.171339.
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Objective.Rheumatoid arthritis (RA) patients’ adherence to disease-modifying antirheumatic drugs (DMARD) is often suboptimal. We examined associations among medication beliefs, self-efficacy, and adherence to medications in RA.Methods.Data were from a longitudinal observational cohort of persons with RA. Subjects completed telephone interviews on self-reported adherence, self-efficacy, demographics, and the Beliefs about Medicines Questionnaire (BMQ), which assesses beliefs in necessity and beliefs about taking medication. Bivariate and multivariate logistic regression identified correlates of poor adherence to synthetic DMARD and prednisone as well as to biologic therapy, including medication concerns and necessity.Results.There were 362 patients who reported taking a synthetic DMARD and/or prednisone. Of these, 14% and 21% reported poor adherence to oral DMARD or prednisone, and biologics, respectively. There were 64% who reported concern about taking medicines, 81% about longterm effects, and 47% about becoming too dependent on medicines. In multivariate analyses, the BMQ necessity score was independently associated with better adherence to oral DMARD or prednisone (adjusted OR 0.61, 95% CI 0.41–0.91), while self-efficacy was associated with greater odds of poor adherence to oral medications (adjusted OR 1.23, 95% CI 1.01–1.59). Beliefs in medicines and self-efficacy were not associated with adherence to biologics.Conclusion.In a diverse cohort of patients with RA, stronger beliefs in the necessity of medication were associated with better adherence to oral DMARD or prednisone, while higher self-efficacy was associated with poor adherence. Providers can play important roles in eliciting patient beliefs about medications to improve adherence and ultimately health outcomes.
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Balsa, Alejandro, Maria Jesus García de Yébenes, and Loreto Carmona. "Multilevel factors predict medication adherence in rheumatoid arthritis: a 6-month cohort study." Annals of the Rheumatic Diseases 81, no. 3 (November 29, 2021): 327–34. http://dx.doi.org/10.1136/annrheumdis-2021-221163.
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Non-adherence challenges efficacy and costs of healthcare. Knowledge of the underlying factors is essential to design effective intervention strategies.ObjectivesTo estimate the prevalence of treatment adherence in rheumatoid arthritis (RA) and to evaluate its predictors.MethodsA 6-month prospective cohort study of patients with RA selected by systematic stratified sampling (33% on first disease-modifying rheumatic drug (DMARD), 33% on second-line DMARD and 33% on biologics). The outcome measure was treatment adherence, defined by a score greater than 80% both in the Compliance Questionnaire in Rheumatology and the Reported Adherence to Medication scale, and was estimated with 95% CIs. Predictive factors included sociodemographic, psychological, clinical, drug-related, patient–doctor relationship related and logistic. Their effect on 6-month adherence was examined by multilevel logistic models adjusted for baseline covariates.Results180 patients were recruited (77% women, mean age 60.8). The prevalence of adherence was 59.1% (95% CI 48.1% to 71.8%). Patients on biologics showed higher adherence and perceived a higher medication need than the others; patients on second-line DMARDs had experienced more adverse events than the others. The variables explaining adherence in the final multivariate model were the type of treatment prescribed (second-line DMARDs OR=5.22, and biologics OR=3.76), agreement on treatment (OR=4.57), having received information on treatment adaptation (OR=1.42) and the physician perception of patient trust (OR=1.58). These effects were independent of disease activity.ConclusionTreatment adherence in RA is far from complete. Psychological, communicational and logistic factors influence treatment adherence in RA to a greater extent than sociodemographic or clinical factors.
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van den BEMT, BART J. F., FRANK H. J. van den HOOGEN, BART BENRAAD, YECHIEL A. HEKSTER, PIET L. C. M. van RIEL, and WIM van LANKVELD. "Adherence Rates and Associations with Nonadherence in Patients with Rheumatoid Arthritis Using Disease Modifying Antirheumatic Drugs." Journal of Rheumatology 36, no. 10 (September 1, 2009): 2164–70. http://dx.doi.org/10.3899/jrheum.081204.
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Objective.Nonadherence in patients with rheumatoid arthritis (RA) using disease modifying antirheumatic drugs (DMARD) may result in unnecessarily high levels of disease activity and function loss. The aim of this descriptive study was to assess adherence rates with self-report measures in a large random population, and to identify potential risk factors for nonadherence.Methods.A randomly selected sample of 228 patients with RA using DMARD was invited for a standardised interview. For each medicine, the patients were asked about adherence, consumption and perceived (side) effects. After the interview, the patients received self-report questionnaires to assess adherence [Compliance Questionnaire on Rheumatology (CQR) and the Medication Adherence Scale (MARS)], coping, beliefs about medicines, satisfaction about medicine information, and physical functioning. Subsequently, associations between adherence and demographics, clinical characteristics, and patient attitudes were examined.Results.Depending on the instrument used, 68% (CQR) and 60% (MARS) of the patients were adherent to DMARD. Nonadherence was not associated with demographic and clinical characteristics, satisfaction about information, medication concerns, and coping styles. The disease duration, the number of perceived side-effects, and beliefs about the necessity of the medicine were weakly associated with adherence.Conclusion.In this large study with a random RA population, 32%–40% of the patients did not adhere to their DMARD prescription. As none of the possible risk factors was strongly related to adherence, no general risk factor seems to be powerful enough as a possible screening tool or target for adherence-improving interventions. This implies that nonadherence barriers should be assessed on an individual basis.
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Jugel, C., C. Baerwald, and O. Seifert. "AB0244 MEDICATION ADHERENCE AND BELIEFS ABOUT MEDICATION IN PATIENTS WITH RHEUMATOID ARTHRITIS." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 1249.2–1250. http://dx.doi.org/10.1136/annrheumdis-2022-eular.618.
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BackgroundConsistent immunosuppressive treatment of rheumatoid arthritis (RA) with disease-modifying anti-rheumatic drugs (DMARDs) is crucial for reduced progression and improved long-term outcome of the disease. Therefore, drug adherence is a prerequisite, which is often insufficient according to literature.ObjectivesOur aim was to investigate the relationship between adherence and beliefs about medication in patients with RA.MethodsThe study included 137 RA patients (102 female, 35 male; age range 28-86 years, Ø 64.8 ± 12.6 yrs; SDAI Ø 9.9 ± 6.8; 61 % DMARD monotherapy, 31 % DMARD combination therapy, 9 % currently treated without DMARD). Medication adherence was measured with the Compliance-Questionnaire-Rheumatology (CQR). This is a self-report questionnaire with 19 items (4 response options each). The sum score is mapped to a scale from 0 to 100 % (CQR%), where 100 % corresponds to optimal adherence. A CQR% ≥ 80 % was defined as satisfactory adherence. In addition, the specific part of the Beliefs about Medicines Questionnaire (BMQ) was used to assess patients’ opinions about the necessity of their medication therapy and their concerns. Besides correlation analyses (Spearman-Rho) multiple linear regression was applied to determine factors influencing adherence (coefficient of determination: adjusted R2).ResultsAdherence was satisfactory in 93 RA patients (67.9 %) and insufficient in almost one-third (n = 44, 32.1 %). Analyses showed that adherence was significantly related to belief in necessity (r = 0.46; p < 0.001) and concerns about drug therapy (r = -0.27; p = 0.001). Furthermore, it became apparent that adherence is closely linked to the age of the patient (r = 0.30; p < 0.001). Younger RA patients (< 60 yrs) had significantly lower CQR%-scores than older RA patients (≥ 60 yrs; p < 0.01). Belief in the necessity of therapy, medication concerns and patient age accounted for almost half of the patient-specific variability in adherence (each p < 0.001; R2 = 42.9 %), suggesting a strong dependence of adherence on these three factors.ConclusionAdherence is insufficient in about one-third of RA patients. Additionally, adherence appears to be strongly dependent on the patient’s belief in the necessity of therapy, medication concerns and age. Physicians should strive for all RA patients to have sufficient knowledge about their medication, strengthen the belief in the necessity of the therapy and be mindful of adherence when talking to patients.Disclosure of InterestsNone declared
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Agnew-Blais, J. C., J. S. Coblyn, J. N. Katz, R. J. Anderson, J. Mehta, and D. H. Solomon. "Measuring quality of care for rheumatic diseases using an electronic medical record." Annals of the Rheumatic Diseases 68, no. 5 (May 29, 2008): 680–84. http://dx.doi.org/10.1136/ard.2008.089318.
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Objectives:The objective of this study was twofold: (1) to determine how best to measure adherence with time-dependent quality indicators (QIs) related to laboratory monitoring, and (2) to assess the accuracy and efficiency of gathering QI adherence information from an electronic medical record (EMR).Methods:A random sample of 100 patients were selected who had at least three visits with the diagnosis of rheumatoid arthritis (RA) at Brigham and Women’s Hospital Arthritis Center in 2005. Using the EMR, it was determined whether patients had been prescribed a disease-modifying antirheumatic drug (DMARD) (QI #1) and if patients starting therapy received appropriate baseline laboratory testing (QI #2). For patients consistently prescribed a DMARD, adherence with follow-up testing (QI #3) was calculated using three different methods, the Calendar, Interval and Rolling Interval Methods.Results:It was found that 97% of patients were prescribed a DMARD (QI #1) and baseline tests were completed in 50% of patients (QI #2). For follow-up testing (QI #3), mean adherence was 60% for the Calendar Method, 35% for the Interval Method, and 48% for the Rolling Interval Method. Using the Rolling Interval Method, adherence rates were similar across drug and laboratory testing type.Conclusions:Results for adherence with laboratory testing QIs for DMARD use differed depending on how the QIs were measured, suggesting that care must be taken in clearly defining methods. While EMRs will provide important opportunities for measuring adherence with QIs, they also present challenges that must be examined before widespread adoption of these data collection methods.
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Pouls, Bart P. H., Charlotte L. Bekker, Fatma Gundogan, Renske CF Hebing, Hein AW van Onzenoort, Liesbeth I. van de Ven, Harald E. Vonkeman, et al. "Gaming for Adherence to Medication using Ehealth in Rheumatoid arthritis (GAMER) study: a randomised controlled trial." RMD Open 8, no. 2 (November 2022): e002616. http://dx.doi.org/10.1136/rmdopen-2022-002616.
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ObjectiveTo examine the effect on adherence to disease modifying anti-rheumatic drugs (DMARDs) in participants with rheumatoid arthritis (RA) of a serious game that targeted implicit attitudes toward medication.MethodsA multicentre randomised controlled trial (RCT) was performed with adults with RA that used DMARDs and possessed a smartphone/tablet. Control and intervention groups received care as usual. The intervention group played the serious game at will during 3 months. Game play data and online questionnaires Compliance Questionnaire on Rheumatology (CQR), Beliefs about Medicine Questionnaire (BMQ), Health Assessment Questionnaire (HAQ) and Rheumatoid Arthritis Disease Activity Index (RADAI) were collected. Primary outcome was DMARD implementation adherence operationalised as the difference in proportion of non-adherent participants (<80% taking adherence) between intervention and control group after 3 months using a Chi-squared test. Two sample t-tests and Wilcoxon rank-sum test were performed to test for differences on secondary outcomes.ResultsOf the 110 intervention participants that started the study, 87 participants (79%) installed the game and had a median playtime of 9.7 hours at 3 months. Overall, 186 participants completed the study. Adherence in intervention group (63%) and control group (54%) did not differ significantly (p=0.13) at 3 months. Neither were there differences oberved in CQR continuous score, beliefs about medication (BMQ) or clinical outcomes (HAQ and RADAI).ConclusionA serious game aimed at reinterpreting attitudes toward medication failed to show an effect on adherence to DMARDs or clinical outcomes in patients with RA. The game was played frequently indicating that it can be an effective channel for reaching patients.Trial registration numberNL7217.
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Koncz, Tamas, Marta Pentek, Valentin Brodszky, Katalin Ersek, Ewa Orlewska, and Laszlo Gulacsi. "Adherence to biologic DMARD therapies in rheumatoid arthritis." Expert Opinion on Biological Therapy 10, no. 9 (August 3, 2010): 1367–78. http://dx.doi.org/10.1517/14712598.2010.510508.
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Barber, Claire E. H., J. Carter Thorne, Vandana Ahluwalia, Jennifer Burt, Diane Lacaille, Deborah A. Marshall, Glen S. Hazlewood, et al. "Feasibility of Measurement and Adherence to System Performance Measures for Rheumatoid Arthritis in 5 Models of Care." Journal of Rheumatology 45, no. 11 (June 15, 2018): 1501–8. http://dx.doi.org/10.3899/jrheum.171284.
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Objective.To test the feasibility of reporting on 4 national performance measures for patients with rheumatoid arthritis (RA) in 5 different models of care.Methods.The following performance measures were evaluated in 5 models of care: waiting time (WT) to rheumatologist consultation, percentage of patients seen in yearly followup (FU), percentage taking disease-modifying antirheumatic drugs (DMARD), and time to starting DMARD. All models aimed to improve early access and care for patients with RA.Results.A number of feasibility issues were encountered in performance measure evaluation because of differences in site data collection and/or the duration of the model of care. For example, while 4/5 programs maintained clinical or research databases, chart reviews were still required to report on WT. Median WT for care in 2015 varied by site between 21 and 75 days. Yearly FU rates could only be calculated in 2 sites (combined owing to small numbers) and varied between 83% and 100%. Percentage of patients taking a DMARD and time to DMARD could be calculated in 3 models, and rates of DMARD use were between 90% and 100%, with median time to DMARD of 0 days in each.Conclusion.Our review has shown that even in models of care designed to improve access to care and early treatment, data to document improvements are often lacking. Where data were available for measuring, deficits in WT performance were noted for some centers. Our results highlight a need to improve reporting processes to drive quality improvement.
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Pasma, Annelieke, Adriaan van ’t Spijker, Jolanda J. Luime, Margot J. M. Walter, Jan J. V. Busschbach, and Johanna M. W. Hazes. "Facilitators and Barriers to Adherence in the Initiation Phase of Disease-modifying Antirheumatic Drug (DMARD) Use in Patients with Arthritis Who Recently Started Their First DMARD Treatment." Journal of Rheumatology 42, no. 3 (December 15, 2014): 379–85. http://dx.doi.org/10.3899/jrheum.140693.
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Objective.To explore themes associated with adherence in the initiation phase for first-time use of disease-modifying antirheumatic drugs (DMARD) in patients with inflammatory arthritis using focus groups and individual interviews.Methods.Thirty-three patients were interviewed in focus groups and individual interviews. Interviews were transcribed verbatim and imported into ATLAS.ti software (Scientific Software Development GmbH). Responses that included reasons for adherence or nonadherence in the initiation phase were extracted and coded by 2 coders separately. The 2 coders conferred until consensus on the codes was achieved. Codes were classified into overarching themes.Results.Five themes emerged: (1) symptom severity, (2) experiences with medication, (3) perceptions about medication and the illness, (4) information about medication, and (5) communication style and trust in the rheumatologist.Conclusion.Perceptions about medication and the communication style with, and trust in, the rheumatologist were mentioned the most in relation to starting DMARD. The rheumatologist plays a crucial role in influencing adherence behavior by addressing perceptions about medication, providing information, and establishing trust in the treatment plan.
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Kawahito, Yutaka, Yuya Takakubo, Akio Morinobu, Naoko Matsubara, Orsolya Nagy, and Eiji Sugiyama. "Patient satisfaction, preferences, expectations, characteristics, and impact of suboptimal control of rheumatoid arthritis: A subgroup analysis of Japanese patients from a large international cohort study (SENSE)." PLOS ONE 16, no. 11 (November 15, 2021): e0259389. http://dx.doi.org/10.1371/journal.pone.0259389.
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Objective To evaluate treatment satisfaction, disease outcomes, and perspectives of patients with poorly controlled rheumatoid arthritis (RA) treated with conventional synthetic, targeted synthetic, or biologic disease-modifying antirheumatic drugs (DMARDs), we conducted a subgroup (post hoc) analysis of Japanese patients participating in the SENSE study. Methods Data for Japanese patients (n/N = 118/1629) from the global, multicenter, cross-sectional, observational SENSE study were analyzed. The primary endpoint was the global satisfaction subscore assessed using the Treatment Satisfaction Questionnaire for Medication (TSQM) version 1.4. Other patient-reported outcomes included self-reported RA medication adherence and Work Productivity and Activity Impairment-RA. Patient perspectives included patients’ expectations and preference of pharmacologic treatment. Results Median (range) age and RA disease duration were 67.0 (18.0–87.0) years and 8 (0.0-54) years, respectively; 81.4% of patients were female. Mean (SD) TSQM global satisfaction subscore was 56.8 (17.5), and only 5.9% of patients reported good satisfaction with treatment (TSQM global ≥80). Mean (SD) self-reported treatment adherence using VAS was high (93.5% [13.8%]). Mean (SD) total work productivity impairment was 45.6% (32.0%); presenteeism contributed toward more total work productivity impairment (43.9% [30.4%]) than absenteeism (8.3% [24.4%]). Patients expected improvement in all parameters from their treatment, especially improvement in joint symptoms. Most patients (80.7%) preferred oral medication and 18.7% preferred monotherapy. Patient acceptability of potentially manageable side effects was high (7.5%-34.0%). Although most patients (81.3%) found combination therapy acceptable, 43.2% were receiving DMARD monotherapy. Conclusion Although most Japanese patients with RA with moderate-to-high disease activity were dissatisfied with their current DMARD treatment, high treatment adherence, high acceptability of combination therapy, high acceptability of manageable potential side effects, and preference for oral medication were reported. Data support the development of a more individualized and patient-centric approach for RA treatment.
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Gaujoux-Viala, C., J. F. Bergmann, M. Goguillot, A. Melaine, M. Guérin, A. Edouard, S. Benard, and B. Fautrel. "POS0627 SUBOPTIMAL MANAGEMENT OF RHEUMATOID ARTHRITIS IN FRANCE: A REAL-WORLD STUDY BASED ON DATA FROM THE FRENCH NATIONAL HEALTH DATA SYSTEM." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 582.1–582. http://dx.doi.org/10.1136/annrheumdis-2022-eular.4470.
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BackgroundCurrently, real-world data on rheumatoid arthritis (RA) treatment patterns in France are limited.ObjectivesThe aim of this study was therefore to describe, between 2013 and 2017, the sequence of therapies used in the treatment of patients with RA and to characterize RA treatment patterns using real-world data.MethodsA non-interventional, longitudinal study was conducted using the Echantillon Généraliste des Bénéficiaires (EGB) between 1 January 2013 and 31 December 2017. EGB is a 1/97th representative random sample from the French National Healthcare Database (SNDS) which includes claims data covering 99% of the total French population.Treatment patterns, adherence and persistence of RA treatments were described in a cohort of patients with RA, identified between 2013 and 2017.ResultsBetween 2013 and 2017, 2,553 patients with RA were identified, including 2,314 in 2017. Of the 2,314 RA patients identified in 2017 (mean age 66.2 ± 15.4 years; 73.7% female; mean Charlson comorbidity score 4.2), 1,102 (47.6%) did not receive any disease-modifying anti-rheumatic drug (DMARD). Of these, 944 (85.7%) had received at least one symptomatic treatment, including 862 (91.3%) an analgesic, 509 (53.9%) an oral corticosteroid and 384 (40.7%) non-steroidal anti-inflammatory drugs.Of the 2,553 RA patients monitored between 2013 and 2017, 1,512 (59.2%) patients received a DMARD, of which 721 (47.7%) patients received only one treatment sequence, mainly methotrexate (n=529, 35.0%), and did not discontinue or switch treatment. Switching treatment to a targeted DMARD was reported for 144 (9.5%) patients. During follow-up, 377 (25%) patients discontinued treatment. In total, 1,142 RA treatment initiations were recorded, 62.4% of which were conventional synthetic DMARDs (csDMARDs). Persistence rates (95% confidence interval) for csDMARDs, TNF inhibitors (TNFi) and other targeted DMARDs (tDMARDs) were 63.4% (59.6–67.0), 55.9% (49.2–62.0) and 59.4% (51.2–66.6) at 12 months, respectively; Medication Possession Ratio (MPR), an adherence indicator, was 80.5%, 90.8% and 71.9%, respectively.Long-term oral corticosteroids (≥6 months) were also associated with csDMARD for 42.6% of cases (n=304/713), TNFi for 39.7% (n=100/252) and another tDMARD for 53.1% (n=94/177). The average doses of long-term oral corticosteroids were 7.5 mg, 6.5 mg and 7.8 mg of prednisone equivalent per day, respectively.ConclusionUsing data obtained from the EGB, this study estimated the number of patients with RA in France to be 307,612 in 2017. Approximately half of the patients identified in the EGB cohort were not treated with a DMARD. For a substantial proportion of patients receiving DMARDs, therapeutic escalation, a switch in treatment, or long-term corticosteroid co-therapy with an average daily dose greater than 5 mg were needed. Furthermore, median persistence for most targeted DMARDs was less than 2 years, and the early discontinuation rates of up to 46.6% suggest poor DMARD tolerance in many patients.This study highlights that the medical need for RA treatment is not covered by current therapeutic strategies.Table 1.Characteristics of DMARD treatments initiated between 2013–2017 in the EGB database (N=1,142)csDMARDTNFiOther targeted DMARDTreatments initiated, n (%)713 (62.4)252 (22.1)177 (15.5)Median duration of treatment, months26.718.514.6Rate of early treatment discontinuation (≤2 dispensations within 2 months of initiation), %15.510.711.9Mean treatment adherence (MPR), %80.590.871.9AcknowledgementsThis study was funded by Galapagos NV (Mechelen, Belgium). Publications management support was provided by Aspire Scientific Ltd (Bollington, UK) and funded by Galapagos NV (Mechelen, Belgium).Disclosure of InterestsCécile Gaujoux-Viala Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, BMS, Celgene, Eli Lilly, Galapagos, Gilead Sciences, Inc., Janssen, Medac, Merck-Serono, Mylan, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi, and UCB, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, BMS, Celgene, Eli Lilly, Galapagos, Gilead Sciences, Inc., Janssen, Medac, Merck-Serono, Mylan, Nordic Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi, and UCB, Jean-François Bergmann Consultant of: AbbVie, Amgen, AstraZeneca, Bayer, BMS, Galapagos, Gilead, GSK, Lilly, Novartis, Roche, Sanofi, and Takeda, Mélanie Goguillot Employee of: Stève Consultants, who carried out the study on behalf of Galapagos, Asma Melaine Employee of: Stève Consultants, who carried out the study on behalf of Galapagos, Marie Guérin Employee of: Galapagos, Alban Edouard Employee of: Galapagos, Stève Benard Employee of: Stève Consultants, who carried out the study on behalf of Galapagos, Bruno Fautrel Speakers bureau: AbbVie, Amgen, Biogen, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medac, MSD, Mylan, NORDIC Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi-Genzyme, SOBI, and UCB, Consultant of: AbbVie, Amgen, Biogen, BMS, Celltrion, Fresenius Kabi, Galapagos, Gilead, Janssen, Lilly, Medac, MSD, Mylan, NORDIC Pharma, Novartis, Pfizer, Roche, Sandoz, Sanofi-Genzyme, SOBI, and UCB, Grant/research support from: AbbVie, Lilly, MSD, and Pfizer
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Peltea, A., F. Berghea, T. E. Gudu, D. Predeteanu, A. Balanescu, V. Bojinca, C. Constantinescu, et al. "THU0499 Patient’s Adherence to Mixed DMARD (Biological and Non-Biological) Therapy." Annals of the Rheumatic Diseases 72, Suppl 3 (June 2013): A332.2—A332. http://dx.doi.org/10.1136/annrheumdis-2013-eular.1027.
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Glintborg, Bente, Dorte Vendelbo Jensen, Sara Engel, Lene Terslev, Mogens Pfeiffer Jensen, Oliver Hendricks, Mikkel Ostergaard, et al. "Self-protection strategies and health behaviour in patients with inflammatory rheumatic diseases during the COVID-19 pandemic: results and predictors in more than 12 000 patients with inflammatory rheumatic diseases followed in the Danish DANBIO registry." RMD Open 7, no. 1 (January 2021): e001505. http://dx.doi.org/10.1136/rmdopen-2020-001505.
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AimsIn Danish patients with inflammatory rheumatic diseases to explore self-protection strategies and health behaviour including adherence to disease-modifying antirheumatic treatment (DMARD) during the initial phase of the COVID-19 pandemic and again after the reopening of the society started. Furthermore, to identify characteristics of patients with high levels of anxiety and self-isolation.MethodsPatients in routine care followed prospectively in the nationwide DANBIO registry were invited to answer an online questionnaire regarding disease activity and COVID-19 infection, behaviour in March and June 2020. Responses were linked to patient data in DANBIO. Characteristics potentially associated with anxiety, self-isolation and medication adherence (gender/age/diagnosis/education/work status/comorbidity/DMARD/smoking/EQ-5D/disease activity) were explored with multivariable logistic regression analyses.ResultsWe included 12 789 patients (8168 rheumatoid arthritis/2068 psoriatic arthritis/1758 axial spondyloarthritis/795 other) of whom 65% were women and 36% treated with biological DMARD. Self-reported COVID-19 prevalence was 0.3%. Patients reported that they were worried to get COVID-19 infection (March/June: 70%/45%) and self-isolated more than others of the same age (48%/38%). The fraction of patients who changed medication due to fear of COVID-19 were 4.1%/0.6%. Female gender, comorbidities, not working, lower education, biological treatment and poor European Quality of life, 5 dimensions were associated with both anxiety and self-isolation.ConclusionIn >12 000 patients with inflammatory arthritis, we found widespread anxiety and self-isolation, but high medication adherence, in the initial phase of the COVID-19 pandemic. This persisted during the gradual opening of society during the following months. Attention to patients’ anxiety and self-isolation is important during this and potential future epidemics.
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Wabe, Nasir, Anita Lee, Mihir Wechalekar, Leah McWilliams, Susanna Proudman, and Michael Wiese. "Adherence to combination DMARD therapy and treatment outcomes in rheumatoid arthritis: a longitudinal study of new and existing DMARD users." Rheumatology International 37, no. 6 (February 3, 2017): 897–904. http://dx.doi.org/10.1007/s00296-017-3655-z.
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Zanetti, Anna, Carlo Alberto Scirè, Lisa Argnani, Greta Carrara, and Antonella Zambon. "Can the adherence to quality of care indicators for early rheumatoid arthritis in clinical practice reduce risk of hospitalisation? Retrospective cohort study based on the Record Linkage of Rheumatic Disease study of the Italian Society for Rheumatology." BMJ Open 10, no. 9 (September 2020): e038295. http://dx.doi.org/10.1136/bmjopen-2020-038295.
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ObjectiveTo describe the adherence to quality of care indicators in early rheumatoid arthritis (RA) and to evaluate its impact on the risk of hospitalisation in a real-world setting.DesignRetrospective cohort study.SettingPatients with early-onset RA identified from healthcare regional administrative databases by means of a validated algorithm between 2006 and 2012 in the Lombardy region (Italy).ParticipantsThe study cohort included 14 203 early-onset RA (71% female, mean age 60 years).Outcome measuresFor each patient, a summary adherence score was calculated starting from the compliance to six quality indicators: (1–2) methotrexate or sulfasalazine or leflunomide with/without glucocorticoids, (3–4) other disease-modifying antirheumatic drugs (DMARDs) with/without glucocorticoids, (5) early interruption of glucocorticoids, (6) early clinical assessment.The relationship between low, intermediate and high categories of the summary score and the 12-month risk of hospitalisation for all causes and for RA was assessed.ResultsDuring a follow-up of 1 year, 2609 hospitalisations occurred, of which 704 were for RA (main or secondary diagnosis) and 252 primarily for RA. In a 7-year period (2006–2012), early DMARDs and timely clinical monitoring treatment increased (from 52% to 62% p trend <0.001 and from 25% to 30% p trend 0.009, respectively).Intermediate and high summary adherence score categories (compared with the low category) were related significantly with a lower risk of hospitalisation (adjusted HR 0.85 (95% CI 0.77 to 0.93), p<0.001 and HR 0.76 (95% CI 0.69 to 0.84), p<0.001, respectively). Among the indicators of the adherence score, early DMARD prescription showed the strongest positive impact, while long-term use of glucocorticoids was the worst negative one.ConclusionIn early RA, adherence to quality standards of care is associated with a lower risk of hospitalisation. Future interventions to improve the adherence to quality standards of care in this setting should decrease the risk of hospitalisation with a significant impact on individual and population health.
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Moreno-Arquieta, I. A., G. G. Sánchez Mendieta, D. E. Flores Alvarado, J. A. Esquivel Valerio, and D. Á. Galarza-Delgado. "AB0868-HPR ADHERENCE TO DISEASE-MODIFYING ANTIRHEUMATIC DRUGS IN RHEUMATIC DISEASES DURING COVID-19 PANDEMIC." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 1458.1–1458. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2131.
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Background:The pandemic COVID-19 has set a new challenge in adherence to treatment in patients with rheumatic diseases. Prior studies in Latin America had reported adherence of 16.4% on Rheumatoid Arthritis (RA) and 45.9% in Systemic Lupus Erythematous (SLE). There is evidence that these patients believe their treatment increases the risk and gravity of COVID-19 and therefore, suspending the treatment could reduce this risk. It has been shown that a “Good adherence” is associated to a better survival.Objectives:Describe the adherence to DMARDs in patients with Rheumatic diseases during COVID-19.Methods:Descriptive, cross-sectional, self-report study conducted in rheumatology outpatient clinic of University Hospital in Monterrey, México. Consecutive patients with RA, SLE, Inflammatory Myopathies and Systemic Sclerosis, were approached during their routine appointments, March 2020 to December 2020 period during COVID-19 pandemic. They were asked how many days of the month they took the DMARD indicated in the previous appointment, with Based on this, adherence was classified into four categories: Good 100-75% (> 21 days), Regular 74-50% (21-15 days), Bad 49-25% (14-8 days) and Null <25% (<7 days). Data was obtained from our internal electronic patient record registry and analyzed with SPSS V.22.Results:n (DMARDs)GoodRegularBadNulln (%)n (%)n (%)n (%)Rheumatoid Arthritis302255 (84.4)13 (4.3)20 (6.6)14 (4.6)Systemic Lupus Erithematous126111 (88)3 (2.3)8 (6.3)4 (3.1)Inflammatory Myopathies1110 (90.9)0 (0)1 (9)0 (0)Systemic Sclerosis3027 (90)2 (6.6)1 (3.3)0 (0)TOTAL469Conclusion:Despite what it is believed, patients are not changing therapeutic regimes. The adherence found in this group of patients was good, for the definition used in this study. It should be considered that the self-report method may overestimate adherence, so the data found must be correlated with objective methods in the future.References:[1]Resende Prudente L, Souza Diniz J, Matteucci Ferreira TXA, Marçal Lima D, Antônio Silva N, Saraiva G, et al. Medication adherence in patients in treatment for rheumatoid arthritis and systemic lupus erythematosus in a university hospital in Brazil. Patient Preference and Adherence. 2016:10 863–870.[2]Michaud K, Wipfler K, Shaw Y, et al. Experiences of patients with rheumatic diseases in the United States during early days of the COVID-19 pandemic. ACR Open Rheumatol 2020. doi:10.1002/acr2.11148.[3]Waimann ChA, Marengo MF, de Achaval S, Cox VL, Garcia-Gonzalez A, Reveille JD. Electronic Monitoring of Oral Therapies in Ethnically Diverse and Economically Disadvantaged Patients With Rheumatoid Arthritis. Arthritis & Rheumatism. 2013:6 1421-1429.Disclosure of Interests:None declared
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Hebing, Renske CF, Iremnur Aksu, Jos WR Twisk, Wouter Bos, Bart Van den Bemt, and Michael T. Nurmohamed. "Effectiveness of electronic drug monitoring feedback to increase adherence in patients with RA initiating a biological DMARD: a randomised clinical trial." RMD Open 8, no. 1 (February 2022): e001712. http://dx.doi.org/10.1136/rmdopen-2021-001712.
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ObjectiveMedication non-adherence in rheumatoid arthritis (RA) is associated with disease flares, increased disability and increased costs. This study assessed the effectiveness of electronic monitoring feedback (EMF) on medication adherence in patients with RA starting with or switching to a new biological disease-modifying antirheumatic drug (bDMARD).MethodsIn this randomised controlled trial, bDMARD starters were assigned to the intervention or control group and followed for 1 year. The intervention group received a needle container with a Medication Event Monitoring System (MEMS) cap registering patient’s adherence to injections. Scores were calculated every 3 months with MEMS and motivational interviewing feedback was given. The control group received usual care. Effectiveness of EMF on adherence was measured with the medication possession ratio (MPR).Results104 consecutive intervention patients were included and 102 controls. MPR was 0.95 (SD: 0.10) and 0.90 (0.16) after 12 months (B: 0.036, 95% CI: 0.001 to 0.007, p=0.045). bDMARD-naive patients receiving EMF achieved low disease activity (LDA) sooner compared with the control group, adjusted for baseline DAS (HR: 1.68, 95% CI: 1.00 to 2.81, p=0.050). Side effects and DAS28 were similar.ConclusionEMF increased adherence for patients with RA starting with or switching to a bDMARD. Especially bDMARD-naive patients achieved LDA sooner compared with the control group, which holds promise for the future.
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Jawad, I., and M. K. Nisar. "AB0810 IMPACT OF TOLERABILITY ON RETENTION OF cDMARDs IN PSORIATIC ARTHRITIS - IS IT A CONCERN?" Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1706.2–1707. http://dx.doi.org/10.1136/annrheumdis-2020-eular.1973.
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Background:Most guidelines recommend the first line use of DMARDs in Psoriatic Arthritis (PsA). However, studies show that many conventional treatments like methotrexate are poorly tolerated. There is hitherto no published real-world data addressing the tolerability of DMARDs in PsA.Objectives:Our objective was therefore to assess the drug management in PsA with focus on tolerability and the reasons for therapy cessation.Methods:We conducted a retrospective analysis of all PsA patients enrolled in electronic database up to April 2019 at our university teaching hospital. We had access to full patient records including details on co-morbidities, drugs and disease managementResults:335 patients were identified with a formal diagnosis of PsA. Mean age of the cohort was 46 years (13-81) and 58% were female. 48% of the group had clinically active disease. Same percentage were taking a single DMARD. 10% had trialled 3 or more drugs. 62% of patients had discontinued one or more DMARDs prior. The mean duration before discontinuing a DMARD was 9.9 months. Methotrexate was the best tolerated and on average discontinued after 13.4 months (range: 4 days to 10.9 years). Sulfasalazine and Hydroxychloroquine were discontinued after an average of 8.4 (11 days to 4.27 years) and 12.5 months (1.3 months to 2.88 years) respectively. Leflunomide was the least tolerated DMARD and stopped after an average of 5.5 months (7 days to 2.53 years). The main reason for stopping a medication was gastro-intestinal symptoms which accounted for 42% of all the reported side effects. This applied to both methotrexate (43%) and sulfasalazine (46%) discontinuation. The leading reasons for discontinuing Hydroxychloroquine were jointly GI symptoms and other side effects at 43% each. Leflunomide was stopped in 50% of cases due to neurological symptoms.Conclusion:To our knowledge, this is the first report confirming poor retention rate of oral DMARDs in a real world PsA cohort managed over 20 years. In the context of chronic disease, the median duration of treatment is short. Our analysis did not include patients who suffer from side effects but continue therapy thereby impacting treatment adherence and hence the true scale of the issue is likely higher. Though NICE guidelines stipulate the need of an adequate trial of minimum two DMARDs prior to therapy escalation, in reality these drugs are not well tolerated and thus pose a challenge to clinicians. One potential solution is earlier adoption of biological therapies, which are increasingly cost effective and have been shown to be better tolerated.Disclosure of Interests:Issrah Jawad: None declared, Muhammad Khurram Nisar Grant/research support from: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Celgene, Novartis and UCB, Consultant of: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Celgene, Novartis and UCB, Speakers bureau: Muhammad Nisar undertakes clinical trials and received support (including attendance at conferences, speaker fees and honoraria) from Roche, Chugai, MSD, Abbvie, Pfizer, BMS, Celgene, Novartis and UCB
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Hsiao, B., J. Downs, M. Lanyon, J. R. Curtis, S. Blalock, C. Wiedmeyer, S. Venkatachalam, W. B. Nowell, and L. Fraenkel. "AB1584-PARE UNDERSTANDING HETEROGENEITY IN PATIENTS’ CONCEPTUALIZATION OF TREATMENT FOR RHEUMATOID ARTHRITIS: A CLUSTER ANALYSIS." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 1890.2–1891. http://dx.doi.org/10.1136/annrheumdis-2022-eular.2964.
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BackgroundUptake of treat to target strategies for the management of rheumatoid arthritis (RA) is low. System-related barriers to accessing treatment are known, but poor adherence to starting and continuing treatment are prevalent causes of suboptimal care.ObjectivesTo better understand heterogeneity in patients’ conceptualization of RA treatment to inform interventions aimed at improving appropriate utilization of disease modifying antirheumatic drugs (DMARDs).MethodsParticipants (pts) were recruited from the ArthritisPower US online research registry. Pts who met eligibility criteria [physician diagnosed RA currently being treated with DMARD(s)] rated 56 items (coded on 5-point scales) reflecting concepts raised during in-depth patient interviews. To combine similar items for ease of analysis and interpretation, we conducted a principal components analysis using Varimax rotation. We then entered mean scores, weighted by how heavily each item loaded onto each factor, into a k-means cluster analysis. We examined whether demographic characteristics differed across clusters using ANOVA for continuous and chi-square for categorical variables.ResultsPts (N= 621) ranged in age from 22 to 93, with a mean of 57 years (SD= 11.5). Most (89%) were female and reported as non-Hispanic white (89%); 27% reported having a post-graduate degree. A scree plot revealed that a 4-factor solution explaining 36.8% of the variance would provide desirable interpretability, with a discontinuous drop in eigenvalues for additional factors slowly tapering and adding little discriminability between later solutions. The four factors (% variance explained, number of items) were: 1) Access to high quality care and support (12.10%, n= 21); 2) Comfortable adding/switching DMARDs (9.73%, n= 14); 3) Perceived favorable DMARD risk/benefit ratio (8.74%, n= 15); and 4) Confidence that testing reflects disease activity (6.20%, n= 6).A 5-cluster solution showed the most stable convergence of cluster centers after 10 iterations. Figure 1 shows the weighted mean scores for each factor across clusters. The largest group (31.7%) is characterized by mean scores on each of the four factors toward the high end of mean responses for the sample, reflecting positive experiences; we labeled this group “Successfully Engaged in Care” to indicate a positive rheumatologist relationship, feeling well-informed and active participation in care. The next group (24.3%) also had high scores for Factor 1 (access to high quality care/support) and Factor 3 (perceived favorable DMARD risk/benefit ratio), but were less comfortable adding/switching DMARDs (Factor 2) and had less confidence in testing reflecting their disease activity (Factor 4); we labeled this group “Worried About Medication”.The three remaining clusters are smaller. The third cluster (16.4%), labeled “Skeptical of Testing,” had a favorable view of DMARDs (Factor 3) despite lower scores related to access and quality of care (Factor 1) and confidence in testing (Factor 4). The fourth cluster (14.3%) expressed low perceived value of DMARDs as well as reduced scores for DMARD risk/benefit and confidence in testing; we labeled this group “Resistant to DMARDs.” The last cluster (13.2%) scored lowest on their rating of access to high quality care and support, indicating less access to, and satisfaction with, information needed to support decision making. Their perceived risk/benefit ratio for DMARDs was still favorable, so we labeled this group “Dissatisfied with Care.”ConclusionPatients’ conceptualization of RA treatment varies, but discomfort with adding/switching DMARDs appears to be ubiquitous regardless of perceived benefits associated with DMARDs and access to high quality care/support. Interventions outside of the traditional physician-patient relationship are needed to facilitate treatment escalation in patients with RA. Further research is required to understand residual variance not explained by our model.AcknowledgementsThe authors thank the patients for their participation.Disclosure of InterestsBetty Hsiao: None declared, Julie Downs: None declared, Mandy Lanyon: None declared, Jeffrey R. Curtis Consultant of: Gilead, Novartis, and Samsung, Grant/research support from: AbbVie, Amgen, BMS, Corrona, Eli Lilly and Company, Janssen, Myriad, Pfizer, Regeneron, Roche, and UCB, Susan Blalock: None declared, Carole Wiedmeyer: None declared, Shilpa Venkatachalam: None declared, W. Benjamin Nowell Grant/research support from: •William B. Nowell is the Principal Investigator on grants/contracts from AbbVie, Eli Lilly and Company, and PCORI, and an employee of the Global Healthy Living Foundation (GHLF). GHLF receives grants, sponsorships and contracts from pharmaceutical manufacturers and private foundations. A full list of GHLF funders is publicly available here: https://www.ghlf.org/our-partners/., Liana Fraenkel: None declared
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Pasma, Annelieke, Johanna M. W. Hazes, Jan J. V. Busschbach, Willemijn H. van der Laan, Cathelijne Appels, Yaël A. de Man, Daan Nieboer, Reinier Timman, and Adriaan van ’t Spijker. "Psychosocial predictors of DMARD adherence in the first three months of treatment for early arthritis." Patient Education and Counseling 100, no. 1 (January 2017): 126–32. http://dx.doi.org/10.1016/j.pec.2016.07.019.
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Pineda-Sic, R., M. M. Castañeda-Martínez, I. D. J. Hernandez-Galarza, E. I. Guevara Elizondo, D. E. Flores Alvarado, G. Serna-Peña, I. J. Colunga-Pedraza, and D. Á. Galarza-Delgado. "AB1187 TREATMENT ADHERENCE: WHAT ABOUT THE RHEUMATOLOGIST?" Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1884.2–1884. http://dx.doi.org/10.1136/annrheumdis-2020-eular.4011.
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Background:Adherence to medications among patients with rheumatic diseases is often suboptimal.1Adherence to treatment has been described to be affected by several factors.2The rheumatologist plays a crucial role in influencing adherence behavior by addressing perceptions about medication, providing information, and establishing trust in the treatment plan.3There is no record of attitudes and thoughts of Mexico’s rheumatologists about adherence to medication.Objectives:To know the rheumatologist’s attitudes regarding treatment adherence in follow up consultation.Methods:Descriptive, cross sectional study. Rheumatologists from across the country were invited to respond an electronic survey created with Google Forms, link was sent by Whatsapp ® message, responses were anonymous. The survey was constructed taking into account the main barriers of adherence related to the doctor. Seven questions were created, from one to six were multiple selections and the seven were open question1.Where do you practice medicine? 2.Do you ask all your patients about adherence medication? 3.If your answer was positive, do you ask individually for each drug? 4.How long do you spend on explaining: side effects, benefits, and mechanisms of action of drugs? 5 Do you discuss available treatment options with your patients to decide one? 6.What’s the definition of adherence? 7.Which activities can the doctor do to improve adherence to their patients?Results:Data were collected from 158 rheumatologists who completed the survey. Regarding the question where they practice medicine, 19.5% answered they work in public medical institutions, 31.8% do private practice and 48.7% work in both of them, 88.3% answered correctly adherence definition, 93% of rheumatologists ask for adherence to medication in the follow up consultation and only 86.1% do it individually for each medication, 97.4% discuss therapeutic options with their patients. The time used to explain treatment is presented in Figure 1. The interventions considered by rheumatologists to increase adherence are reported in Table 1.Table 1Interventions considered by rheumatologists to increase adherencePatient education(in follow up consultation, conferences, pamphlets)Develop rapportwith patient. (“be accessible”, “answer questions” “make the patient part of“ don’t be paternalistic or authoritarian”)Adherence measure(Use the available method, questionnaires, self-report, drug levels, electronic pillbox, pill count, etc. “Don’t matter which one, measure it!“)Interventions for no adherence reasons(phone calls, text messages, telephone alarms) fixed schedules for each medication, cognitive-behavioral therapy, access to medications)Family support networkPresented in order to frequencies and grouped by topicConclusion:Rheumatologists ask for adherence medication but more than half use a limited amount of time to explain about medication, nevertheless, they think that patient education is the best intervention to increase adherence.References:[1]Pasma, Annelieke et.al Facilitators and Barriers to Adherence in the Initiation Phase of Disease modifying Antirheumatic Drug (DMARD) Use in Patients with Arthritis Who Recently Started Their First DMARD Treatment, The Journal of Rheumatology (2013) DOI:10.3899/jrheum.140693.[2]M.F. M. Improving treatment adherence in patients with rheumatoid arthritis: What are the options? Int J Clin Rheumtol. 2015;10(5):345–56.[3]Voshaar et al. Barriers and facilitators to disease modifying antirheumatic drug use in patients with inflammatory rheumatic diseases: a qualitative theory-based study. BMC Musculoskeletal Disorders (2016) 17:442 DOI 10.1186/s12891-016-1289-zDisclosure of Interests:None declared
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Coppes, T., N. Jessurun, J. Jansen, K. Velthuis, P. ten Kloster, and H. Vonkeman. "POS0620 TREATMENT PATHWAYS OF RHEUMATOID ARTHRITIS PATIENTS LEADING TO BIOLOGIC THERAPY VISUALIZED IN A SANKEY DIAGRAM." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 547.2–548. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2299.
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Background:Treatment of rheumatoid arthritis (RA) has changed in the past 20 years due to the arrival of biologic disease-modifying antirheumatic drugs (bDMARDs) and the application of treat to target strategies. Many different combinations of conventional synthetic (cs)DMARDS and bDMARDS are being applied in daily practice. It is difficult to visualize and understand all the different treatment pathways that are sequentially being used over longer periods of time in a real-world setting. We therefore investigated whether a Sankey diagram is a suitable tool to study and visualize which treatment pathways exist and to what extent a RA treatment protocol is being followed.Objectives:To illustrate the treatment pathways over longer periods of time in a cohort of early RA patients and to assess adherence to the treatment protocol using Sankey diagrams.Methods:This single-centre retrospective, observational cohort study used data from the DREAM-RA registry. Patients were treated according to a treat to target strategy with a step-up DMARD treatment protocol when remission was not achieved, initial steps were starting with MTX 15 mg/wk, week 8 MTX 25 mg/wk, week 12 MTX+SSZ 2dd1000mg, week 20 MTX+SSZ 3dd1000mg, week 24 MTX+adalimumab 40mg/2wk, week 36 MTX+adalimumab 40mg/wk. Although the protocol met full consensus, adherence to the protocol in individual patients was at the discretion of the treating rheumatologist. In this study, patients were included if they received a continuous treatment with a conventional synthetic or biologic DMARD between 1 January 2002 and 30 April 2020. During treatment, corticosteroids per protocol were allowed but not considered as an individual treatment. Evaluated outcomes included: the consecutive treatments that patients followed including start- and stop-date of treatments, the proportion of patients that received bDMARDs, the number of switches until first bDMARD, and time to first bDMARD. Furthermore, the lower limit of adherence to the protocol was estimated by considering all patients (% of total) treated according to the protocol. This information was determined by verifying whether the patient was being treated according to the protocol after each switch.Results:A total of 372 patients were included in this study (Table 1). The mean overall follow-up time of the cohort was 8.83 (± 3.59) years. The follow-up time for the first 4 treatments, depicted in the Sankey diagram was 6.28 (± 3.31) years. At least 45 (12%) patients started with a bDMARD before all previous protocol steps were followed. At the start of treatment, 81% of the patients were treated according to the protocol, this was reduced to 28% after one switch. The lower limit of adherence to the predefined protocol after 3 switches were roughly 5% of all patients.Table 1.Absolute counts of T-cell subpopulations at baseline, after 6 and 12 m of TCZ therapyAll patients(n=372)Gender, female, n (%)246 (66.1)Age, year, mean ± SD67.9 ± 13.61Overall follow-up, years ± SD8.83 ± 3.59Follow-up first 4 treatments, years ± SD6.28 ± 3.31Baseline DAS-28 score, mean ± SD3.60 ± 1.41Rheumatoid factor positive, n (%)336 (90.3)Patients who eventually received a bDMARD, n (%)108 (29.0)Number of switches until first bDMARD, mean ± SD2.7 ± 1.41Time to first bDMARD, years ± SD3.66 ± 3.00Figure 1.Sankey diagram of the treatment pathway of the first 3 switches of RA patients. The average duration of treatment of a flow is displayed in years if the flow included more than 20 patients. (MTX= methotrexate; SSZ= sulfasalazine; HCQ = hydroxychloroquine; LEF= leflunomide; bDMARD= monotherapy bDMARD; Combi csDMARDs= combination therapy of csDMARDS; csDMARD(s)+bDMARD= combination therapy of one or two csDMARD(s) + a bDMARD; No therapy= no treatment received >3 months; Other = medication that is not a (cs)(b)DMARD)Conclusion:Sankey diagramming can be used to illustrate complex real-world treatment data of a treat to target cohort of RA patients. Treatment protocol adherence can be assessed with the help of a Sankey diagram. After 3 switches, the lower limit of adherence to the protocol was roughly 5%.Disclosure of Interests:Tristan Coppes: None declared, Naomi Jessurun: None declared, Jurriaan Jansen: None declared, Kimberly Velthuis: None declared, Peter ten Klooster: None declared, Harald Vonkeman Consultant of: BMS, Celgene, Celltrion, Galapagos, Gilead, Janssen-Cilag, Lilly, Novartis, Pfizer, Sanofi-Genzyme, Grant/research support from: Abbvie
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Pasma, A., J. M. Hazes, J. J. Busschbach, W. H. van der Laan, C. Appels, Y. de Man, D. Nieboer, R. Timman, and A. van 't Spijker. "OP0197-HPR Psychosocial Predictors of DMARD Adherence in The First Three Months of Treatment for Early Arthritis." Annals of the Rheumatic Diseases 75, Suppl 2 (June 2016): 131.1–131. http://dx.doi.org/10.1136/annrheumdis-2016-eular.1695.
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Thakran, R., S. Baghel, C. Messi, V. Kumar, S. Kapoor, S. Garg, and A. Malaviya. "SAT0644-HPR COMPLIANCE OF BIOLOGIC DISEASES MODIFYING ANTI-RHEUMATIC DRUGS (BDMARDS) WITH SYSTEMIC IMMUNO-INFLAMMATORY RHEUMATIC DISEASES (SIRDS). AN ASSESSMENT OF PATIENTS’ ADHERENCE AND NON- ADHERENCE CONCERNS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1281.1–1281. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3026.
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Background:Patients with systemic immunoinflammatory rheumatic diseases (SIRDs) are often treated with bDMARDs when the response to conventional disease-modifying antirheumatic drugs (csDMARDs) is inadequate.There are, however, concerns about non-adherence to bDMARDs among patient. The non-adherence to bDMARDs may be caused by the various factors.Objectives:1.The main objective of present study was to find out the cause of discontinuation of bDMARDs2.To find out the adherence and non-adherence rate for bDMARDs.3.To identify the factors that are modifiable.Methods:800patients with SIRDs prescribed bDMARDs were interviewed to find out the demographic information, their socioeconomic status,and the disease duration.Additional information gathered included the comorbidities, the time for starting bDMARDs, the route of administration of bDMARDs, beliefs and perceptions about treatment efficacy and side effects if any.This was followed by looking at the adherence of bDMARDs; if they had discontinued then efforts was made to find out the reasons for the same.Based on these findings the patients were classified into adherent and non-adherent categories. The data were analyzed further for1.Factors that associated with persistence of bDMARDs.2.Factors that were associated with discontinuation of bDMARDs.Results:A total of 800 patients were interviewed that included patients with ankylosing spondylitis 430(52.4%), rheumatoid arthritis 300(37.7%), psoriatic arthritis 45(5.2%), and others 25 (0.7%).On analysis 610(76%) patient were compliant but 190(24%) patient had discontinued the bDMARDs on their own. On comparison of both groupsFactors that were significantly related to self-discontinuation were:•Negative beliefs about biologics (37%)•Cost (33%)•Reading side-effect profile on Google search (25%)•Other co-morbidities (6%)Factors that were significantly related to persistence of biologic treatment were:•Good counseling by rheumatologist and rheumatology nurse (60%)•Faith in the treating rheumatologist (25%)•Fear of deformities and pain(15%)On analysis it was found that a good counseling and clarifying the doubts of the patients regarding bDMARDs before starting the treatment encourages the patient to continue the biologic treatment, especially it allays their doubts about the drug adverse effects.Conclusion:Despite negative beliefs and misconceptions about bDMARDs, patient non-adherence at our center is not alarming.A positive reinforcement counseling appears to be the most significant factor to overcome the negative belief of patients.The affordability of the biologic treatment however remains a limiting factor in our centre as in other parts of India.References:[1]Tamas Koncz,MD,Marta,Pentek,Valentin,Brodszky,Katalin Ersek,MSc,Ewaorlewska&Laszlo Gulasi Volume10,2010 –Issue9 Adherence to biologic DMARD therapies in rheumatoid arthritisAcknowledgments:noDisclosure of Interests:None declared
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Roodenrijs, N. M. T., M. C. Van der Goes, P. Welsing, J. Tekstra, F. Lafeber, J. W. G. Jacobs, and J. M. Van Laar. "FRI0074 UNDERLYING PROBLEMS AND IMPACT OF DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS: PRELIMINARY RESULTS OF A CROSS-SECTIONAL CASE-CONTROL STUDY." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 613.2–614. http://dx.doi.org/10.1136/annrheumdis-2020-eular.369.
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Background:Difficult-to-treat (D2T) RA is defined here by signs and symptoms, suggestive of active/progressive RA, which are perceived as problematic by rheumatologist and/or patient, and are present despite treatment according to EULAR recommendations including ≥2 b/tsDMARDs with different mechanisms of action.1Its treatment is generally based on trial-and-error and challenged by several underlying problems (Figure 1),2-4of which the exact impact is unknown.Objectives:To obtain insight into the potential problems underlying D2T RA and into its impact.Methods:Consecutive RA patients fulfilling the 2010 ACR/EULAR classification criteria, treated according to current standard of care for ≥1 year, are being enrolled, and categorised as D2T or not (controls). Potential problems underlying D2T RA (Figure 1) and its impact on quality of life and physical functioning were assessed and compared between the two patient groups.Results:In this preliminary analysis, 45 patients are classified as having D2T RA and 100 are controls (Table 1). Fibromyalgia (33 vs 9%), depression (18 vs 4%), a mismatch between patient and rheumatologist in wish to adapt treatment (51 vs 15%) and DMARD discontinuation because of adverse events (96 vs 57%), were statistically significantly more frequent in D2T RA patients than in controls. Higher levels of threatening illness perception and helplessness, and more comorbidities according to EULAR domains were found in D2T RA patients (Figure 2). Other potential problems did not differ statistically significantly.Table 1.Patient characteristicsD2T RA (n=45)Control RA (n=100)p-valueDemographicsAge‡60.9 (10.8)64.5 (10.9)0.061Female, %76720.662Disease characteristicsDisease duration, years17.0 (10.0-27.5)14.0 (8.0-24.0)0.183RF positivity, %76650.212ACPA positivity, %71650.472DAS28-ESR4.0 (3.4-5.7)2.5 (1.8-3.3)<0.0013DrugsNumber of previous DMARDs7 (5-10)2 (1-4)<0.0013Number of current DMARDs2 (1-2)1 (1-2)0.033 Current conventional synthetic DMARDs, %74860.072 Current biological DMARDs, %57390.062 Current targeted synthetic DMARDs, %220<0.0012Glucocorticoid therapy, %5316<0.0012 Dose, mg/day prednisone or equivalent daily, in users7.5 (5.0-13.8)5.0 (5.0-7.5)0.033ACPA: anti-citrullinated protein antibodies; D2T: difficult-to-treat; DAS28-ESR: disease activity score assessing 28 joints using erythrocyte sedimentation rate; DMARD: disease-modifying antirheumatic drug; mg: milligram; n: number; RF: rheumatoid factor.Numbers are median (interquartile range), unless stated otherwise;‡mean (standard deviation).Differences between groups were analysed using: 1. Independent T-test; 2. Chi-square Test; 3. Mann-Whitney U Test.Quality of life and physical functioning were significantly lower in D2T RA patients than in controls (median (IQR) EQ-5D 2.6 (1.8-3.0) vs 1.6 (1.4-2.2) and HAQ 1.8 (1.3-2.1) vs 1.0 (0.5-1.4), p<0.001).Conclusion:This first prospective study describing a cohort of D2T RA patients shows higher occurrences of potential underlying problems and a higher clinical impact. These should be recognised in daily practice and taken into account before considering another DMARD switch. More detailed research on disease state (biomarkers, radiographic damage) and use of medication (drug levels and in-depth interviews on treatment non-adherence) will follow.References:[1]Smolen JSet al. Ann Rheum Dis2020. Epub ahead of print.[2]Buch MH.Ann Rheum Dis2018;77:966–9.[3]de Hair MJHet al. Rheumatology2017;57:1135–44.[4]Roodenrijs NMTet al. Ann Rheum Dis2018;77:1705–9.Disclosure of Interests:Nadia M. T. Roodenrijs: None declared, Marlies C. van der Goes: None declared, Paco Welsing: None declared, Janneke Tekstra: None declared, Floris Lafeber Shareholder of: Co-founder and shareholder of ArthroSave BV, Johannes W. G. Jacobs Grant/research support from: Roche, Jacob M. van Laar Grant/research support from: MSD, Genentech, Consultant of: MSD, Roche, Pfizer, Eli Lilly, BMS
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Murray, K., S. Quinn, M. Turk, A. O’rourke, E. Molloy, L. O’neill, A. B. Mongey, U. Fearon, and D. Veale. "POS1216 SYMPTOM RATES, ATTITUDES AND MEDICATION ADHERENCE OF RHEUMATIC AND MUSCULOSKELETAL DISEASE PATIENTS DURING THE SARS-CoV2 PANDEMIC." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 891.2–892. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2579.
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Background:SARS-CoV2 has caused over two million deaths globally. The relationship between rheumatic and musculoskeletal disease (RMDs), immunosuppressive medications and COVID-19 is unclear.Objectives:This study explores the rates of COVID-19 symptoms and positive tests, DMARD adherence and attitudes to virtual clinics. amongst RMD patients.Methods:An online population survey was disseminated via the Arthritis Ireland website and social media channels.Results:There were 1381 respondents with RMD, 74.8% were on immunosuppressive medication. COVID-19 symptoms were reported by 3.7% of respondents of which 0.46% tested positive, no different from the general population at that timepoint. The frequency of COVID-19 symptoms was higher for respondents with spondyloarthropathy [odds ratio (OR) 2.06, 95% CI: 1.14, 3.70] and lower in those on immunosuppressive medication (OR 0.48, 95% CI: 0.27, 0.88), and those compliant with health authority (HSE) guidance (OR 0.47, 95% CI: 0.25, 0.89). Adherence to RMD medications was reported in 84.1%, with 57.1% using health authority guidelines for information on medication use. Importantly, adherence rates were higher amongst those who cited guidelines (89.3% vs 79.9%, P <0.001), and conversely lower in those with COVID-19 symptoms (64.0% vs 85.1%, P =0.009). Finally, the use of virtual clinics was supported by 70.4% of respondents.Conclusion:The rate of COVID-19 positivity in RMD patients was similar to the general population. COVID-19 symptoms were lower amongst respondents on immunosuppressive medication and those adherent to medication guidelines. Respondents were supportive of HSE advice and virtual rheumatology clinics.Disclosure of Interests:Kieran Murray Grant/research support from: Bresnihan Molloy and Newman fellowships, Sean Quinn: None declared, Matthew Turk: None declared, Anna O’Rourke: None declared, Eamonn Molloy: None declared, Lorraine O’Neill: None declared, Anne Barbara Mongey: None declared, Ursula Fearon: None declared, Douglas Veale: None declared.
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Ahmed Narikkoottungal, S., A. Siddiqui, A. Constantin, S. Farrow, and K. Ahmed. "POS1177 REVAMPING BIOLOGIC THERAPY DURING COVID-19." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 869.1–870. http://dx.doi.org/10.1136/annrheumdis-2021-eular.1008.
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Background:The COVID-19 pandemic has caught us all by surprise – from governments to individuals; the medical fraternity being no exception. It has affected all walks of life; with its immense contagiosity, diverse and intriguing pathogenesis and manifestations differing from other viruses. It has indeed left humanity in dark, unchartered waters; particularly in the early months of the pandemic.Objectives:This article shares the experience, in a Rheumatology department in a District General Hospital (DGH) in the United Kingdom, of managing patients on Biologic (b) and Targeted Synthetic (ts) DMARDs, in the midst of the COVID-19 Pandemic.Methods:All Rheumatology patients at the Princess Alexandra Hospital (PAH) in Harlow newly started on a biologic or targeted synthetic DMARD between 3rd July and 3rd Oct 2020 were identified. These patients had active inflammatory arthritis. Each patient was discussed in a dedicated Multi-Disciplinary Team (MDT) meeting and a consensus on treatment reached in-line with local and National guidelines.Figure 1.A slide presented at the Essex Rheumatology Association (ERA) meeting explaining the process adopted at the Rheumatology Department at Harlow during the peak of COVID-19 pandemic with new b/ts DMARD patients.Results:Of the 50 patients identified; 39 had Rheumatoid Arthritis, 6 had Ankylosing Spondylitis and 5 had Psoriatic Arthritis. Of these 50 patients, 5 patients decided against treatment during the stage of ‘Enhanced Verbal Consent’. These patients were flaring recurrently and were in regular contact with the department. However, they were afraid to start new Biologic treatment because of the risks of Covid-19. The breakdown of the biologic agents used in the remaining 45 patients were as follows: Adalimumab:11, Rituximab: 10, Etanercept: 9, Tofacitinib: 11, Tocilizumab SC: 3, Tocilizumab IV: 1, Sarilumab: 2, Secukinumab: 1, Infliximab: 1, Baricitinib: 1, Apremilast: 1Figure 2.Breakdown of the various b/ts DMARD agents newly started in the 45 patients between 3/7/20 - 3/10/20 at PA Hospital, Harlow, UKConclusion:The over-riding principle that guided the Department during the COVID crisis was: primum non nocere (first, do no harm). The adherence to the Case Based Discussions (CBDs) positively impacted on decision making, ensuring safe initiation of Biologic DMARDs even during the height of the pandemic. This is vital to achieve early disease remission. The MDT meetings comprising Doctors, Specialist Pharmacist and Nurse Specialists ensured prompt risk stratification of individual patients. It gave patients the opportunity to be part of the decision-making - evident in the five of the fifty patients, who opted to defer the start date of their treatments. The choice of the new Biologic agent was based on the latest National COVID-19 guidelines. The agents with the shortest half-life were selected. Moreover, patients for Rituximab were given one pulsed infusion, as opposed to two infusions. Only one of the 45 patients started on a Biologic agent over this period, either was tested positive or had symptoms suggestive of COVID-19.References:[1]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261974[2]https://rmdopen.bmj.com/content/6/2/e001314[3]https://www.nejm.org/doi/full/10.1056/nejmc2009567[4]https://www.jrheum.org/content/early/2020/05/13/jrheum.200527[5]https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-care-of-adult-patients-with-systemic-rheumatic-disease[6]www.england.nhs.uk/clinical-guide-rheumatology-patients-v1-19-march-2020.pdf[7]https://www.rheumatology.org.uk/practice-quality/covid-19-guidance[8]https://www.nice.org.uk/guidance/ng167/chapter/4-Treatment-considerations[9]https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/decision-making-and-consentAcknowledgements:We acknowledge the whole Rheumatology Dept at Harlow for their sincere team work during the COVID-19 pandemic – Sabaa Naz (Rheumatology Pharmacist), Mona Kamal Zou (Biologics Nurse Specialist), Lily Robinson (DMARD Nurse Specialist), Mary Surendran (Osteoporosis Nurse Specialist), Janet Bell (Secretary to Dr Ahmed) and Claire Stroud (Secretary to Dr Farrow).Disclosure of Interests:None declared.
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Gόmez, C., M. L. García, E. Galindez, O. Fernández, E. Ruíz, I. Calvo, E. Guerrero, et al. "AB0304 Adherence To DMARD and Subcutaneous Biological Therapy among Rheumatoid Arthritis and Psoriatic Arthritis Patients at Basurto University Hospital." Annals of the Rheumatic Diseases 75, Suppl 2 (June 2016): 1004.1–1004. http://dx.doi.org/10.1136/annrheumdis-2016-eular.3915.
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Cubillos Escobar, E., K. Maldonado-Cañón, P. Coral Alvarado, P. A. Mendez Patarroyo, W. Bautista-Molano, and G. Quintana Lopez. "AB0254 ASSOCIATED FACTORS WITH TREATMENT ADHERENCE IN RHEUMATOID ARTHRITIS: A CROSS-SECTIONAL ANALYTIC STUDY OF COLOMBIAN PATIENTS." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 1254. http://dx.doi.org/10.1136/annrheumdis-2022-eular.1365.
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BackgroundRheumatoid arthritis (RA) represents an essential public health problem regarding vast influence on the individual’s global health. Adherence to pharmacological therapy has been shown to be a relevant outcome to ensure the desired therapeutic objectives and thus avoid the recurring concern of flares, the perpetuation of inflammation, and its consequences, not only physiological but also structural and socioeconomic.ObjectivesOur aim was to identify clinical-epidemiological variables associated with treatment adherence in an outpatient clinic-based cohort of Colombian RA patients.MethodsWe conducted a cross-sectional analytic study with data obtained from August 2020 to October 2021. Treatment adherence was assessed on each visit through the Compliance Questionnaire on Rheumatology (CQR); moreover, patients were stratified into those who were adherent to the treatment and those who didn’t, according to their CQR score. Additional information regarding the quality of life (QOL-RA), disease activity (DAS28 ESR), and functionality (HAQ) was recovered from electronic clinical charts. Data was gathered on a database stored in REDCap. T-test and Chi-squared test were used for comparisons and a multiple logistic regression with backward selection was performed to build the final fitted model.ResultsData from a total of 564 patients were included in the analysis. Our population was constituted of 79.1% women with a mean age of 53 (± 13.1); the CQR mean score was 77.7 (± 9.26) and treatment adherence, defined as a CQR score of ≥ 80.7, was seen in 49.3% of the cases. Mean DAS28 ESR, QOL-RA, and HAQ scores were 3.3 (± 1.62), 7.24 (± 1.43), and 0.671 (± 0.716), respectively; with a reported preserved quality of life (QOL-RA >7) in 60,5% of patients. Monotherapy (42.7%) and combined therapy (49-6%) were the two most common treatment schemes, being MTX the more frequent DMARD (58.9% oral, 20.9% subcutaneous). Noncompliant patients showed higher mean disease activity (3.52 (±1.66) vs 3.08 (±1.54); p 0.001) and lower quality of life (6.94 (±1.43) vs 7.56 (±1.35); p <0.001) scores. Having a higher DAS28 score (OR 1,19), drug dispensing delay (OR: 1,71), and infection as an adverse effect (OR 2.53) were recognized as risk factors for an impaired treatment adherence after adjustment for the effects of possible confounders. Complete results of the multiple logistic regression model are shown in Table 1.Table 1.Associated factors with treatment adherence in RA patients.Odds Ratio (95% Confidence Interval)p-valueAge0,99 (0,97 – 1)0,12Male1,54 (0,98 – 2,43)0,065Having a stable partner0,75 (0,52 – 1,09)0,13Comorbidities Hypothyroidism0,69 (0,41 – 1,15)0,16 Dyslipidemia0,52 (0,22 – 1,16)0,12Dyspepsia (AE)1,48 (0,97 – 2,28)0,07Infection (AE)2,53 (1,31 – 5,08)0,007Perception of the information received by health professionals0,45 UnsatisfiedRef. Satisfied2,23 (0,06 – 28,1)0,55 Very satisfied1,37 (0,09 – 17,2)0,81Healthcare barriers1,98 (0,92 – 4,45)0,088Drug dispensing delay1,71 (0,99 – 2,99)0,058Disease duration (months) until rheumatology consultation1,00 (0,99 – 1,00)0,004DAS28 ESR score1,19 (1,06 – 1,33)0,003AE: adverse effect. Bold values indicate a p value < 0,1ConclusionIn our study population, there were evident trends regarding the effects of dispensing delays, adverse effects, and barriers to access to the health system on reducing treatment adherence. Moreover, there was a subtle association of treatment adherence with the DAS28 score, as well as with a better quality of life. Taken together, these results suggest the need for the implementation of educational programs that will support a comprehensive approach that considers not only patient-related factors but also the proper functioning of the healthcare system itself. Further research with a follow-up period could assess the long-term effects on several clinical outcomes and explore if proposed trends change with time.Figure 1.Density plot comparing disease activity in patients that are compliant and noncompliant to treatment.Disclosure of InterestsNone declared
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Castañeda, S., J. I. Cantero, C. Alegre, E. Chamizo, A. García, M. E. García, E. Garmendia, et al. "SAT0363 Agreement Degree on the Adherence to Disease-Modifying Antirrheumatic Drugs (DMARD) Treatment in Rheumatoid Arthritis in Spain. Results of the Observar Study." Annals of the Rheumatic Diseases 74, Suppl 2 (June 2015): 790.3–791. http://dx.doi.org/10.1136/annrheumdis-2015-eular.3624.
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Koutsogianni, K., E. Repa, K. Spanidou, I. Papadakis, I. Chatzikrystallis, P. Pratsidou-Gertsi, and F. Asimakopoulou. "POS1567-PARE ASSESSMENT OF ADHERENCE AMONG GREEK PATIENTS WITH RHEUMATIC DISEASES DURING THE COVID-19 ERA." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 1130.1–1130. http://dx.doi.org/10.1136/annrheumdis-2022-eular.4336.
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BackgroundPatient’s (pts) adherence is a EULAR important recommendation for an optimal disease course and outcome. COVID-19 pandemic has globally challenged the issue of adherence. As relevant Greek data are lacking, the PanHellenic Federation “Rheumazein” (i.e., co-living with a Rheumatic Disease) conducted a survey among their members to assess adherence and a possible COVID-related negative impact.ObjectivesThe main endpoint of the study aimed to capture the degree of pt adherence to treatment, either with conventional synthetic or/and biologic DMARDS (csDMARDS, bDMARDS). The secondary endpoints were: a. To record pts’–physicians’ interactive communication to assess the level of shared disease making (SDM). b. The emerged barriers to medication access during the pandemic and consequent restrictive measures. c. To record pt perceptions on the usefulness of mobile reminder applications towards an uninterrupted regimen.MethodsA 29-item quantitative questionnaire was uploaded in the social media of the Federation and its associations, in order to register pts’ responses on the aforementioned sections. The questionnaire was accessible for a 58-day period (21/09/2021-17/11/2021).ResultsParticipants’ characteristics: The responses of 303 adults with RD (M:F 63:240), aged (in yrs) 18-44: 35%, 45-54: 26%, >55: 38% respectively, were available for analysis. The RD types were RA 33%, AS 18%, PsA 13%, SLE 18%, Juvenile Arthritis 5% and Other RD 13%, respectively. Τhe education level was low/moderate 39%, high 30%, post-graduate 31%, respectively. Receivers of a monotherapy with either cs- or bDMARDS were 93(31%) and 83(27%), of a combined regimen cs+bDMARDs 114(38%) and off treatment 13 (4%). BDMARD receivers were mostly AS pts (93%) while the least, SLE pts (48%). The route of bDMARD administration (sc vs iv did not significantly differ (57% vs. 43%). Since diagnosis, the mean disease trajectory was 7.6 yrs, the mean time on medication 6.9 yrs, while the mean duration on the current regimen 3 yrs, respectively. Adherence: At least one skipped dose during the last trimester was reported, significantly more often by pts under csDMARDs than by those under bDMARDs, (60% vs. 40%, p<0.001) with a mean number of 2.7 vs. 1.8 skipped doses, respectively. Additionally, the main reasons of non-adherence under csDMARDs and bDMARDs significantly differed only in respect to pt responsibility (56% vs.19% p<0.001), but not for COVID-related reasons, namely fear either of getting infected, or due to a performed COVID vaccination (35% vs 42%), or due to physician recommendations (22% vs. 32%). Regarding the pt-physician interactive discussions on emerging new treatments, 90% of the pts reported this policy, but only 40% of them in a rather frequent to more frequent rate. In respect to satisfaction, 67% expressed a moderate to high satisfaction regarding the level of provided information, while the degree of their satisfaction was positively related with the frequency of these discussions. The main topics focused on the route and frequency of the medication, especially with bDMARD receivers. Of note, 80% of the bDMARD group participated in the SDM before commencing this therapy, but just 20% in the selection of the brand name. Only a minority of pts (17%) were aware of the existence of mobile applications, reminding the scheduled drug administration; however, they rated these programs as very useful (4.3 according to a 0-5 scale). Despite the difference source of supply of cs and bDMARDs on pt access to treatment, the impact of COVID-19 and consequent restrictive measures had not impaired it (1.5/5 and 1.7/5 by the above scale, respectively).ConclusionA significant percentage of pts skip scheduled DMARD administrations, especially those (60%) under csDMARDs. The relationship with the physician was considered relatively satisfactory. Most of the pts did not have any mobile phone reminder application regarding their dose. Finally, the COVID-19 pandemic appeared to have had little effect on pts’ access to both cs- and bDMARDs and consequently, adherence to their treatments.Disclosure of InterestsNone declared
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Cobilinschi, C., M. Danila, D. Opris-Belinski, I. Saulescu, L. Groseanu, S. Daia-Iliescu, C. Codreanu, et al. "AB1269 REGIONAL DIFFERENCES IN THE PATIENTS’ UNDERSTANDING OF TREATMENT STRATEGY IN RHEUMATOID ARTHRITIS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1925.3–1926. http://dx.doi.org/10.1136/annrheumdis-2020-eular.4747.
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Background:The treat-to target (T2T) concept is the standard for treating rheumatoid arthritis (RA) patients worldwide1. However, difficulties that patients encounter in achieving disease control may differ between regions, which may impact the type of support needed for successful T2T implementation.Objectives:To compare differences in patient-reported challenges to controlling RA-related issues between Romanian and US patients.Methods:A cross-sectional study that recruited 403 RA patients was conducted in six centers in Romania. Patients were invited to complete an RA-related questionnaire. We compared their responses to those from a previous published study that included patients with RA from the US2. The survey included items on subjective beliefs about RA treatment (e.g. adherence, cost, adverse events) and knowledge about T2T strategy. Approval for US data use was given by the study coordinator2.Results:All patients in the Romanian cohort were Caucasian, with a mean age of 58.7 years (SD 11.6). 78% were females and the mean disease duration was 11.2 years (SD 8.3). Data was concordant with results from the previously published study. More patients from US had college education (60% vs 43.9%).Among the respondents, 93.3% Romanians were on a synthetic DMARD versus 97.7% Americans and 64.01% were currently on a biologic of choice compared to 74% patients in the US. More than half of the patients in both regions had a history of biologic DMARD use.Asked to grade (0very good, 10very bad) their disease activity on the survey day, a large category of patients (37.4%, SD 14.1) marked an average state (4-6), while 19.08% (SD 11.2) were feeling poorly related to their disease.Patients were asked to define their adherence to RA treatment in the last 30 days. While the US study reported that 93% of patients were adherent2, in our study only 62.5% of the Romanian patients reported adherence (p<0.01). A significantly lower proportion of Romanian patients were aware of T2T strategy (35 %, p 0.04).Regarding patient beliefs on their disease, statements were grouped into categories such as difficulty managing pain, medication safety, adherence, lifestyle. Most European patients would agree to change treatment to lower pain. Almost 82% stated they would accept rare adverse events in order to avoid invalidity, to confirm a better future outcome. US patients were more prone to stick to current therapy than escalade to increase clinical response. However, asked about novel therapies, Romanians were reluctant to changing treatment despite insufficient benefit, if the risk of cancer was noted. There was a high agreement that a delay in treatment would be unsatisfactory for both familial and professional chores.Conclusion:There are regional differences in knowledge and perceptions about RA treatment. Romanian patients know less on T2T algorithm. Improving awareness of the T2T strategy among RA patients may need different types of support depending on the patient’s place of residence.References:[1]Smolen, J. S.et al.EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update.Ann. Rheum. Dis.76,960–977 (2017).[2]Owensby, J. K.et al.Patient- and Rheumatologist- Perspectives Regarding Challenges to Achieving Optimal Disease Control in Rheumatoid Arthritis.Arthritis Care Res. (Hoboken).0–2 (2019).Disclosure of Interests:CLAUDIA COBILINSCHI Speakers bureau: novartis, Maria Danila Speakers bureau: as personally stated, Daniela Opris-Belinski Speakers bureau: as declared, Ioana Saulescu Speakers bureau: Eli-Lilly, Pfizer, Laura Groseanu Speakers bureau: novartis, eli-lilly, ucb, pfizer,sandoz, Sanziana Daia-Iliescu Speakers bureau: sandoz, Catalin Codreanu Consultant of: Speaker and consulting fees from AbbVie, Accord Healthcare, Alfasigma, Egis, Eli Lilly, Ewopharma, Genesis, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB, Speakers bureau: Speaker and consulting fees from AbbVie, Accord Healthcare, Alfasigma, Egis, Eli Lilly, Ewopharma, Genesis, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB, Razvan Ionescu Speakers bureau: as personally stated, Magda Parvu Consultant of: Speaker fee and consultant: Pfizer, Novartis, Roche, Abbvie, UCB, Eli-Lilly, Speakers bureau: Speaker fee and consultant: Pfizer, Novartis, Roche, Abbvie, UCB, Eli-Lilly, Horatiu Popoviciu Speakers bureau: as personally stated, CODRINA ANCUTA Consultant of: AbbVie, Pfizer, Roche, Novartis, UCB, Ewopharma, Merck Sharpe and Dohme, and Eli Lilly, Speakers bureau: AbbVie, Pfizer, Roche, Novartis, UCB, Ewopharma, Merck Sharpe and Dohme, and Eli Lilly, Elena Rezus: None declared, Claudia Mihailov Speakers bureau: as personally stated, Ruxandra Ionescu Consultant of: Consulting fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Speakers bureau: Consulting and speaker fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz
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Church, S., K. Hyrich, K. Ogungbenro, R. Unwin, A. Barton, and J. Bluett. "POS0665 DEVELOPMENT OF A BIOCHEMICAL TOFACITINIB ADHERENCE ASSAY IN RHEUMATOID ARTHRITIS: THE ORAL ADHERE STUDY." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 605–6. http://dx.doi.org/10.1136/annrheumdis-2022-eular.242.
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BackgroundTofacitinib is a potent inhibitor of the JAK1/JAK3 tyrosine kinases effective in the treatment of rheumatoid arthritis (RA). Unlike biologic DMARDs, tofacitinib is administered orally. Oral administration offers a major benefit to patients, removing the risk of injection site reactions and previous research has shown that patients prefer an oral DMARD which may affect patient’s adherence (1).Non-adherence is a health behaviour that results in reduced response and increased healthcare costs but can be challenging to accurately measure. Direct tofacitinib measurement may be an accurate measure of adherence that could, in the future, be used in a clinical setting as part of a behaviour change intervention.Tofacitinib can be measured using High Performance Liquid Chromatography Selected Reaction Monitoring Mass Spectrometry (HPLC-SRM-MS). Previous tofacitinib studies have demonstrated an assay sensitivity of 0.1ng/ml may be sufficient for the detection of adherence following 5mg twice daily administration (2).ObjectivesThe aim of this study is to develop a HPLC-SRM-MS assay to measure biochemical tofacitinib adherence in patients with RA.MethodsHuman serum for method development was obtained from volunteers recruited to the collection of blood and urine samples from volunteers for the development of analytical methods study (UREC 12346) and the National Repository Study (REC 99/8/84) following informed consent.Samples were spiked with Tofacitinib/Tofacitinib-d3 and subjected to protein precipitation. LC-MS/MS analysis was performed on a TSQ Vantage triple quadrupole mass spectrometer coupled with an Accela UHPLC system (Thermo Fisher Scientific, USA). Validation of the assay was tested as adapted from European Medicines Agency guidelines on Bioanalytical Validation. Specifically, the lower limit of quantification (LLOQ), carryover, accuracy, linearity, precision, recovery and stability of the assay was determined.To investigate the ability of the assay to detect adherence, serum samples (n=10) of patients prescribed tofacitinib from the Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate (BRAGGSS) were analysed (REC reference: 04/Q1403/37). Participants self-reported date and time of tofacitinib ingestion prior to venepuncture. Samples were analysed in triplicate.ResultsThe assay demonstrated a tofacitinib LLOQ of 0.1ng/ml, carryover of sample following injection of a 1000 ng/ml tofacitinib was <1%, linearity of r2=0.998, within run accuracy was between 81-85% at LLOQ and between 91-107% at all other levels. Between run accuracy was within 14.9% at LLOQ and within 0.2-5.1% of the nominal concentration at all other levels. Samples of tofacitinib spiked in whole blood and left at room temperature for seven days were within 0.98-10.25% of serum samples spiked on the day of analysis for all concentrations. To demonstrate the potential of the assay to determine adherence, all 10 BRAGGSS samples revealed tofacitinib levels above 0.1ng/ml with CV<15% (Table 1).Table 1.Sample IDTime difference between self-reported tofacitinib ingestion and blood sample (hours)Mean Tofacitanib (ng/ml, n=3)CV (%)497.026.432.82402.8100.555.51703.673.232.27681.5150.378.09201.5137.469.09301.8117.8514.97331.490.891.18795.4217.4711.40172.8108.437.43372.5335.043.48ConclusionA novel tofacitinib LC-MS/MS assay has been developed. The ability of the assay to measure biochemical adherence has been explored. Further research to establish the sensitivity of the assay and the ability of the assay to detect non-adherence are required.References[1]Alten R, Krüger K, Rellecke J, Schiffner-Rohe J, Behmer O, Schiffhorst G, et al. Examining patient preferences in the treatment of rheumatoid arthritis using a discrete-choice approach. Patient Prefer Adherence. 2016;10:2217-28.[2]Suzuki M, Tse S, Hirai M, Kurebayashi Y. Application of Physiologically-Based Pharmacokinetic Modeling for the Prediction of Tofacitinib Exposure in Japanese. Kobe J Med Sci. 2017;62(6):E150-E61.AcknowledgementsFinancial support was provided as an Investigator Sponsored Research Grant from Pfizer LimitedDisclosure of InterestsStephanie Church Grant/research support from: Financial support was provided as an Investigator Sponsored Research Grant from Pfizer Limited, Kimme Hyrich Speakers bureau: Honoraria as a speaker received from Abbvie, Grant/research support from: Financial support was provided as an Investigator Sponsored Research Grant from Pfizer Limited.Research grant award from BMS, Kayode Ogungbenro Consultant of: Afferent, Biogen, Buzzard, Grant/research support from: Financial support was provided as an Investigator Sponsored Research Grant from Pfizer Limited., Richard Unwin Grant/research support from: Financial support was provided as an Investigator Sponsored Research Grant from Pfizer Limited, Anne Barton Grant/research support from: Financial support was provided as an Investigator Sponsored Research Grant from Pfizer Limited. AB has received grant funding from Scipher Medicine Ltd, Bristol Myers Squibb and Galapagos in the past 12 months., James Bluett Grant/research support from: Financial support was provided as an Investigator Sponsored Research Grant from Pfizer Limited. JB has received travel/conference fees from UCB, Pfizer and Eli Lilly
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Taylor, P. C., P. Sidiropoulos, C. Ancuta, I. Lagunes-Galindo, M. Delavega, U. Kalyoncu, O. Nagy, and A. Kawakami. "POS0512 DIFFERENCES IN TREATMENT SATISFACTION, PATIENT PREFERENCES, AND TREATMENT PATTERNS BETWEEN EUROPEAN, SOUTH AMERICAN, AND JAPANESE PATIENTS WITH SUBOPTIMALLY CONTROLLED RHEUMATOID ARTHRITIS: A SUBGROUP ANALYSIS OF THE SENSE STUDY." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 489–90. http://dx.doi.org/10.1136/annrheumdis-2021-eular.842.
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Background:Despite the availability of advanced therapies, many patients with rheumatoid arthritis (RA) do not achieve their treatment goals. Understanding geographic influence on patient perspectives and physicians’ attitudes toward treatment adjustments may inform region-specific strategies to improve outcomes in RA.Objectives:To explore differences in treatment satisfaction, patient preferences, and treatment strategies between patients from Europe (EU), South America (SA), and Japan (JP) with suboptimal control of RA.Methods:This is a subgroup analysis of SENSE, a non-interventional cross-sectional study in adults with RA who had moderate/high disease activity as measured by Disease Activity Score in 28 joints with erythrocyte sedimentation rate (DAS28[ESR]) >3.2, despite disease-modifying antirheumatic drug (DMARD) treatment. Patient satisfaction and preferences, treatment adherence, patient-reported outcomes, and physicians’ plans for DMARD switch were assessed as previously described.1 Predictors of good treatment satisfaction and physician’s decision not to switch DMARDs were identified using multiple logistic regression analyses.Results:Of 1234, 272, and 118 patients enrolled from EU, SA, and JP, respectively, 13.9%, 15.4%, and 5.9% reported good treatment satisfaction. Irrespective of region, patients reported impaired quality of life and good treatment adherence, and around one-third of patients received targeted synthetic (ts) or biologic (b) DMARDs. Among patients treated with ts/bDMARDs, monotherapy was most common in SA (45.3%), followed by EU (26.3%) and JP (18.8%), consistent with a greater acceptance of combination therapy in JP. More than 80% of JP patients preferred oral treatments versus <60% of EU/SA patients. DMARD switches were planned in 51.8% (EU), 57.4% (SA), and 38.1% (JP) of patients, most commonly to a tumor necrosis factor inhibitor. Predictors for good treatment satisfaction included treatment with ts/bDMARDs and the presence of psychiatric disorders in EU and SA; however, current disease activity was not a common predictor (Table 1). Reluctance to switch treatments was predicted by lower disease activity assessed by DAS28(ESR) (all regions) and current treatment with ts/bDMARDs (EU/SA).Table 1.Predictors for good treatment satisfaction and no treatment switch plannedOR (95% CI)Europe(n=1234)South America(n=272)Japan(n=118)Good treatment satisfaction (TSQM global treatment satisfaction ≥80)Current treatment with ts/bDMARDs3.8 (2.7, 5.4)****4.9 (2.2, 10.8)****—Psychiatric disorders2.4 (1.3, 4.6)**3.1 (1.2, 8.4)*—Number of comorbidities——2.3 (1.2, 4.3)*Worst joint pain—1.3 (1.1, 1.5)**SF-36 MCS1.0 (1.0, 1.1)****—1.3 (1.1, 1.5)**SF-36 PCS1.1 (1.0, 1.1)****——Work Productivity and Activity Impairment–Rheumatoid Arthritis:Total activity impairment—1.0 (1.0, 1.0)***—DAS28(ESR) >5.1—0.3 (0.1, 0.7)**—Female——0.1 (0.0, 0.9)*No treatment switch plannedCurrent treatment with ts/bDMARDs3.9 (3.0, 5.2)****2.4 (1.4, 4.2)**—Number of comorbidities1.2 (1.1, 1.4)****——Age——1.0 (1.0, 1.1)*TSQM effectiveness subscore1.0 (1.0, 1.0)***1.0 (1.0, 1.0)***—Number of concomitant medications0.9 (0.8, 1.0)**——DAS28(ESR)0.5 (0.5, 0.6)****0.6 (0.5, 0.8)***0.6 (0.4, 0.9)*X2 test: ****p<0.0001, ***p<0.001, **p<0.01, *p<0.05CI, confidence interval; OR, odds ratio; SF-36 M/PCS, 36-Item Short-Form Survey mental/physical component summary; TSQM, Treatment Satisfaction Questionnaire for MedicationConclusion:In patients with moderate to high RA disease activity, current disease control was a common determinant of treatment switches. Predictors for good treatment satisfaction revealed region-specific patient attitudes to treatment acceptance despite poor disease control.References:[1]Taylor PC, et al. Ann Rheum Dis 2020;79:996–7Acknowledgements:AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and participated in the writing, review, and approval of this abstract. No honoraria or payments were made for authorship. Medical writing support was provided by Hilary Wong, PhD, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.Disclosure of Interests:Peter C. Taylor Speakers bureau: AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Eli Lilly, Fresenius, Galapagos, Gilead, GSK, Janssen, Nordic Pharma, Pfizer, Roche, Sanofi, and UCB., Consultant of: AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Eli Lilly, Fresenius, Galapagos, Gilead, GSK, Janssen, Nordic Pharma, Pfizer, Roche, Sanofi, and UCB., Grant/research support from: AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Eli Lilly, Fresenius, Galapagos, Gilead, GSK, Janssen, Nordic Pharma, Pfizer, Roche, Sanofi, and UCB., Prodromos Sidiropoulos Speakers bureau: AbbVie, Amgen, MSD, Novartis, Pfizer, Roche, and UCB., Consultant of: AbbVie, Amgen, MSD, Novartis, Pfizer, Roche, and UCB., Grant/research support from: AbbVie, Amgen, MSD, Novartis, Pfizer, Roche, and UCB., CODRINA ANCUTA Speakers bureau: AbbVie, Eli Lilly, Ewopharma, MSD, Novartis, Pfizer, Roche, and UCB., Consultant of: AbbVie, Eli Lilly, Ewopharma, MSD, Novartis, Pfizer, Roche, and UCB., Ivan Lagunes-Galindo Employee of: AbbVie employee and may own stocks or options, Maria DeLaVega: None declared, Umut Kalyoncu Speakers bureau: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, Roche, and UCB., Consultant of: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, Roche, and UCB., Orsolya Nagy Employee of: AbbVie employee and may own stocks or options, Atsushi Kawakami Speakers bureau: AbbVie, Actelion, Asahi Kasei, Astellas, Boehringer Ingelheim, Celltrion, Chugai, Daiichi Sankyo, Eisai, Eli Lilly, GSK, Janssen, Kowa, MedPeer, Mitsubishi Tanabe, Novartis, ONO, Pfizer, Taisho, and Takeda, Grant/research support from: AbbVie, Actelion, Asahi Kasei, Astellas, AYUMI, Boehringer Ingelheim, Bristol-Myers Squibb, Celltrion, Chugai, Daiichi Sankyo, Eisai, Eli Lilly, Kyowa Hakko Kirin, MSD, Neopharma, Novartis, ONO, Sanofi, Taisho, Takeda Science Foundation, and Teijin.
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Ta, V., O. Schieir, M. F. Valois, G. Hazlewood, C. Hitchon, L. Bessette, D. Tin, et al. "FRI0030 MORE THAN HALF OF NEWLY DIAGNOSED RA PATIENTS ARE NOT CONVINCED OF THE NECESSITY OF RA MEDICINES: ASSOCIATIONS WITH RA CHARACTERISTICS, SYMPTOMS, AND FUNCTION IN THE CANADIAN EARLY ARTHRITIS COHORT (CATCH)." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 588.1–588. http://dx.doi.org/10.1136/annrheumdis-2020-eular.4328.
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Background:Although DMARDs are essential for early aggressive control of RA to reduce symptoms and disability, medication adherence is variable. Beliefs about the necessity of medications and safety concerns predict adherence and are modifiable.Objectives:To examine associations among RA medication necessity beliefs and concerns, sociodemographics, RA characteristics, symptom level and function in newly diagnosed RA patients.Methods:Baseline data were analyzed from participants in the Canadian Early Arthritis Cohort (CATCH) who enrolled between 2017-2020 and completed the Beliefs about Medicine Questionnaire (BMQ) and PROMIS-29. All met ACR1987 or 2010 ACR/EULAR criteria and had active RA at enrollment. BMQ Necessity (N) and Concerns (C) scores were classified ashigh(≥20) orlow(<20) and categorized into: Accepting (↑N ↓C); Ambivalent (↑N↑C); Sceptical (↓N↑C); and 4) Indifferent (↓N↓C). Groups were compared using ANOVA and chi-square tests.Results:The 362 patients were mostly white (83%) women (66%) with a mean (SD) age of 56 (15), symptom duration of 6 (3) months, and 32% were obese (BMI≥30). More than half (56%) were DMARD-naive or minimally exposed. Mean N and C scores were similar between men and women; 54% were classified asIndifferent, 31%Accepting, 9%Ambivalent,and 6%Sceptical.As compared to those classified asAccepting, moreIndifferent participantssmoked, had a healthy weight, lower TJCs, and trend for lower CDAI (Table). Groups were similar by sociodemographics, symptom duration, and DMARD/steroid use, except fewerIndifferentpatients received MTX.Indifferentpatients had statistically and meaningfully lower patient global, depression, anxiety, fatigue and pain interference, and higher function and participation scores (Table).Conclusion:Many new RA patients had low medication necessity beliefs and concerns, and only 31% had high necessity beliefs and low concerns around diagnosis. Lifestyle and lower CDAI, TJCs, symptoms and functional impacts were associated with RA medication indifference. Identifying medication indifference can prompt discussions about medication beliefs/concerns to facilitate shared decision-making and adherence.Disclosure of Interests:Viviane Ta: None declared, Orit Schieir: None declared, Marie-France Valois: None declared, Glen Hazlewood: None declared, Carol Hitchon Grant/research support from: UCB Canada; Pfizer Canada, Louis Bessette Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB Pharma, Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck, Novartis, Pfizer, Sanofi, Diane Tin: None declared, Carter Thorne Consultant of: Abbvie, Centocor, Janssen, Lilly, Medexus/Medac, Pfizer, Speakers bureau: Medexus/Medac, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB, Gilles Boire Grant/research support from: Merck Canada (Registry of biologices, Improvement of comorbidity surveillance)Amgen Canada (CATCH, clinical nurse)Abbvie (CATCH, clinical nurse)Pfizer (CATCH, Registry of biologics, Clinical nurse)Hoffman-LaRoche (CATCH)UCB Canada (CATCH, Clinical nurse)BMS (CATCH, Clinical nurse, Observational Study Protocol IM101664. SEROPOSITIVITY IN A LARGE CANADIAN OBSERVATIONAL COHORT)Janssen (CATCH)Celgene (Clinical nurse)Eli Lilly (Registry of biologics, Clinical nurse), Consultant of: Eli Lilly, Janssen, Novartis, Pfizer, Speakers bureau: Merck, BMS, Pfizer, Edward Keystone Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Pfizer Pharmaceuticals, Sanofi-Aventis, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Biotest, Bristol-Myers Squibb Company, Celltrion, Crescendo Bioscience, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, UCB., Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb Canada, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Vivian Bykerk: None declared, Susan J. Bartlett Consultant of: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie, Speakers bureau: Pfizer, UCB, Lilly, Novartis, Merck, Janssen, Abbvie
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Nowell, W. B., J. Curtis, F. Xie, H. Zhao, D. Curtis, K. Gavigan, S. Venkatachalam, et al. "THU0564 PARTICIPANT ENGAGEMENT IN AN ARTHRITISPOWER REAL-WORLD STUDY TO CAPTURE SMARTWATCH AND PATIENT-REPORTED OUTCOME DATA AMONG RHEUMATOID ARTHRITIS PATIENTS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 523–24. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2355.
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Background:Clear characterization of how different types of patient-generated data reflect patient experience is needed to guide integration of electronic patient-reported outcome (ePRO) measures and biometrics in generating real-word evidence (RWE) related to rheumatoid arthritis (RA).Objectives:To characterize the level of participant (pt) engagement/adherence and data completeness in an ongoing study of 250 RA pts enrolled in the Digital Tracking of Arthritis Longitudinally (DIGITAL) study1of the ArthritisPower real-world registry.Methods:ArthritisPower pts with RA were invited to join a digital RWE study with 14-day lead-in and 12-week main study period. In the lead-in, pts were required to electronically complete: a) two daily single-item Pain and Fatigue numeric rating scales and b) longer weekly sets of ePROs. Successful completers of the lead-in were mailed a smartwatch (Fitbit Versa) and study materials. The smartwatch collected activity, heart rate, and sleep duration/quality biosensor data; a study-specific customization of the ArthritisPower mobile application collected ePROs. The main study period included automated and manual reminders/prompts about completing ePROs, wearing the smartwatch and regularly syncing it. Study coordinators monitored pt data and contacted pts via email, text and/or phone to resolve adherence issues during the conduct of the study based on pre-determined rules triggering pt contact. Rules were based chiefly on consecutive spans of missing data. Pts were considered adherent in giving complete data for each week if providing (1) daily ePROs for ≥5 of 7 days/week, (2) weekly ePROs and (3) ≥80% of synced activity data for ≥5 of 7 days/week. Composite adherence for the first month of the main study period required meeting >70% weekly adherence parameters during the first 30 days, ie completing daily ePROs for ≥5 of 7 days/week, weekly ePROs ≥3 of 4 weeks and ≥80% of synced activity data for ≥5 of 7 days/week.Results:As of December 2019, 170 ArthritisPower members enrolled and completed at least 30 days of the main study period; 92.9% female with mean (SD) age 52.5 (10.7) and 10.5 (10.4) years since diagnosis. The overall conversion rate from initial interest to successful completion of the lead-in period was 49.0%. Pts who advanced to the main study were significantly more likely than those who did not to be currently employed (52.9% vs. 41.8%, p=0.038) and be on biologic DMARD monotherapy (64.7% vs. 47.5%, p=0.001). Overall, daily ePRO data had the lowest adherence with 70.0% of pts providing >70% of the requested data consistently across the first 30 days of the main study period (Figure 1). Composite adherence was met by 66.5% of pts. The most common time of day to provide ePRO data was morning, in the hours around scheduled app and email notifications at 10 a.m. in pt’s local time zone. Activity data had the highest adherence and persistence, with 92.9% of pts providing 80% or more of activity data for each 24-hour period in the first 30 days (Figures 1 & 2). Observed weekly adherence did not decline over time. Of 5100 possible person days in the study at day 30, we observed 643 days (91.0% of actual to maximum possible total patient days) where activity data was provided for at least 80% of the 24-hour period.Conclusion:RWE studies involving passive data collection in RA require pt-centric implementation and design to minimize pt burden, promote longitudinal engagement and maximize adherence. Passive data capture via activity trackers such as smartwatches, along with regular contact such as automated reminders, may facilitate greater pt adherence in providing longitudinal data for clinical trials.References:[1]Nowell WB, et al. JMIR Res Protoc. 2019;8(9):e14665.Disclosure of Interests:W. Benjamin Nowell: None declared, Jeffrey Curtis Grant/research support from: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Corrona, Janssen, Lilly, Myriad, Pfizer, Regeneron, Roche, UCB, Fenglong Xie: None declared, Hong Zhao: None declared, David Curtis: None declared, Kelly Gavigan: None declared, Shilpa Venkatachalam: None declared, Laura Stradford: None declared, Jessica Boles: None declared, Justin Owensby: None declared, Cassie Clinton: None declared, Ilya Lipkovich Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Amy Calvin Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Virginia S. Haynes Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company
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Chaparro del Moral, Rafael, Oscar Luis Rillo, Mariana Benegas, María de los Angeles Correa, Gustavo Citera, José A. Maldonado Cocco, Gustavo Casado, et al. "Adherencia al tratamiento de pacientes con artritis reumatoidea que reciben medicamentos biológicos." Revista Argentina de Reumatología 24, no. 4 (December 1, 2013): 18–26. http://dx.doi.org/10.47196/rar.v24i4.44.
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Introducción: Al igual que en otras enfermedades crónicas, la adherencia al régimen terapéutico de los pacientes con artritis reumatoidea (AR) es baja (entre 30 y 80%), dependiendo de la definición de adherencia y de la metodología empleada para medirla. En este estudio se propone determinar el nivel de adherencia al tratamiento en pacientes con AR que reciben DMAR biológicas e identificar factores asociados a la falta de cumplimiento a la terapia. Material y métodos: Se realizó un estudio analítico, observacional de corte transversal en donde se incluyeron pacientes consecutivos con AR según criterios de clasificación (ACR’87) que se encontraban recibiendo fármacos biológicos para el tratamiento de su enfermedad en los últimos seis meses y que asistieron a la consulta ambulatoria. Para la valoración de la adherencia a DMAR se utilizaron los cuestionarios CQR (Compliance Questionnaire on Rheumatology) y el cuestionario SMAQ (Simplified Medication Adherence Questionnaire). Resultados: Se encuestaron 345 pacientes. Mediante el cuestionario SMAQ se observó una adherencia del 50% (159 pacientes). El Cuestionario CQR tuvo un puntaje mediano de 78 puntos (RIC 67-86). El 47% (147 pacientes) fueron adherentes (CQR >80). Sobre los pacientes incluidos, 151 (48%) refirieron no haber tenido ningún retraso, pérdida o adelanto de la dosis del biológico en los últimos 6 meses de tratamiento. El 52% no adherentes tuvo como causas: 146 (46%) pérdida de al menos una dosis del biológico con una mediana de dosis perdidas de 2 (RIQ: 1-3); 117 (37%) tuvo al menos un retraso en las dosis del biológico y 8 (2%) delantó la dosis. Los factores asociados al no cumplimiento de la terapia biológica fueron el tipo de cobertura médica, que el paciente no haya notado mejoría y la esperanza de una rápida respuesta al tratamiento, y la falta de adherencia a DMAR.
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Mena-Vázquez, N., F. G. Jiménez-Núñez, M. Rojas-Giménez, L. Cano Garcia, S. Manrique Arija, and A. Fernandez-Nebro. "POS0521 FACTORS ASSOCIATED WITH SUBCLINICAL ATHEROSCLEROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 494.1–494. http://dx.doi.org/10.1136/annrheumdis-2021-eular.1561.
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Objectives:To describe the prevalence of subclinical atherosclerosis measured as carotid intima-media thickness (cIMT) in patients with rheumatoid arthritis (RA) and to analyze the associated factors.Methods:We performed an observational study of 60 patients with RA and 60 sex and age-matched controls. Patients with dyslipidemia were excluded. The main variable was the cIMT measured by ultrasound. The maximum cIMT was measured and atheromatous plaque was defined as focal thickening of the arterial wall protruding toward the lumen and measuring >0.5 mm or more than 50% of the neighboring cIMT. The other variables included were clinical and laboratory values, lipid metabolism, the 28-joint Disease Activity Score (DAS28), International Physical Activity Questionnaire (METs) and Adherence to a Mediterranean diet (MEDAS). Descriptive, bivariate and two multivariate models were constructed to identify factors associated with pathologic cIMT in all subjects and other in RA patients.Results:The baseline characteristics of both groups are shown in Table 1. The RA patients did not have differences in the mean (SD) of maximum cIMT in relation to the controls (0.77 [0.1] vs 0.75 [0.1]; p = 0.392), nor in the number of plaques (16 [26.7%] vs 10 [16.7]; p = 0.184). The factors associated with maximum cIMT in the total sample were male sex (ß= 0.182; p = 0.039), age (ß = 0.010; p <0.001), METs (ß= -2.19; p = 0.008), MEDAS (ß = -0.177; p = 0.038); While the factors associated with maximum cIMT in patients with RA were: male sex (ß = 0.155; p = 0.003), age (ß = 0.005; p = 0.007), MEDAS (ß = -0.022; p = 0.017), DAS28 (ß = 0.036; p = 0.003) and ACPA (ß = 0.082; p = 0.052).Table 1.Baseline characteristics of 60 patients with RA and 60 controls.VariablePatients n=60Controls n=60p-valueAge in years, mean (SD)54.0 (11.1)54.2 (110.4)0.943Female sex; n (%)53 (88.3)51 (85.0)0.591Smoking0.300 Never smoked, n (%)27 (45.8)30 (54.5) Exsmoker, n (%)23 (39.0)14 (25.5) Active smoker, n (%)9 (15.3)11 (20,0)BMI (kg/m2), mean (SD)28.0 (5.5)27.3 (4.9)0.540MET-minute, median (IQR)533.2 (605.1)809 (716.9)0.028MEDAS, median (IQR)9.4 (1.8)9.1 (2.1)0.349Progression of RA, months, mean (SD)119.7 (84.1-170.5)--Diagnostic delay, months, median (IQR)5.7 (5.1-14.4)--Erosions, n (%)25 (43.1)--RF >10, n (%)45 (75.0)0 (0.0)<0,001ACPA >20, n (%)48 (80.0)0 (0,0)<0,001High-sensitivity CRP (mg/dl), median (IQR)8.1 (4.2)2.0 (4.5)0.009ESR (mm/h), median (IQR)21.1 (16.6)13.9 (12.3)0.008DAS28 at protocol, mean (SD)3.1 (2.2-4.2)--Synthetic DMARDs, n (%)52 (88.1)-- Methotrexate, n (%)36 (61.0)-- Leflunomide, n (%)6 (10.2)-- Sulfasalazine, n (%)7 (11.9)-- Hydroxychloroquine, n (%)4 (6.8)Biologic DMARDs, n (%)32 (54.2)-- Anti TNF-α, n (%)23 (39.0)-- Jak inhibitor, n (%)1 (1.7)-- Anti-IL-6, n (%)6 (10.2)-- Abatacept, n (%)1 (1.7)--Abbreviations: RA, rheumatoid arthritis; ACPA, anti-citrullinated peptide antibodies; RF, rheumatoid factor; SD, standard deviation; MEDAS: Mediterranean Diet Adherence Survey; DAS28, 28-joint Disease Activity Score; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; DMARD, disease-modifying antirheumatic drug; IL-6, interleukin 6; Anti TNF, anti–tumor necrosis factor.Conclusion:In patients with well-controlled established RA, subclinical atherosclerosis is associated, in addition to sex, age, and mediterranean diet, with inflammatory activity and ACPA value.Acknowledgements:Grant for Medical Researchers from “Fundación Española de Reumatología” 2019Grant from “Fundación Española de Reumatología” 2018 for non-funded projects.Disclosure of Interests:None declared
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Quéré, B., I. Lemelle, A. Lohse, P. Pillet, J. Molimard, O. Richer, C. Sordet, et al. "POS1314 JUVENILE IDIOPATHIC ARTHRITIS IN THE CONTEXT OF THE CORONAVIRUS DISEASE 19 PANDEMIC: IMPACT ON THE DECREASE IN TREATMENT AND THE RETURN TO SCHOOL." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 939.2–940. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2838.
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Background:The SARS-CoV-2 pandemic has induced an exceptional sanitary crisis, potentially having an impact on treatment continuation, for juvenile idiopathic arthritis (JIA) patients receiving immunosuppressive therapies. In France, after the first lockdown from March to May 2020, many parents and children were then also concerned about whether reopening plans for school could ensure the safety of students, despite data concerning children with COVID-19 seem reassuring, and very few of them develop severe forms of the disease (1, 2, 3).Objectives:Our objectives were to evaluate the impact of the COVID-19 pandemic on the therapeutic management of JIA, the frequency of returning to school after the first lockdown period and the prevalence of SARS-CoV-2 infection at the time of the survey.Methods:JIA patients under 18 years of age, usually treated with disease-modifying anti-rheumatic drugs (DMARDs) were prospectively included during their outpatient visit and completed a standardized questionnaire. Data regarding the general characteristics of the participants, medical history, SARS-CoV-2 infection, characteristics of JIA subtypes and treatment modifications were collected.Results:A total of 173 patients from 8 different expert centers were included between May and August 2020. Their mean age was 11.6 years (± 4.1 years), and most of them 31.2% (54/173) had a rheumatoid factor-negative polyarticular JIA. Fifty percent (86/172) were treated with methotrexate, and 72.5% (124/171) were treated with bDMARDs. DMARD treatment modification in relation to the pandemic was observed in 4.0% (7/173) of participants, our results reflect good adherence of the patient/parents to their immunosuppressive treatments. 49.1% (81/165) of the patients did not return to school due to a personal/parental decision in 69.9% (55/81) of cases, due to anxiety of the patient/parents regarding COVID-19. Two patients were diagnosed positive for SARS-CoV-2 infection.Conclusion:This study suggests that JIA patients treated with DMARDs continued their treatment during the pandemic. In contrast, parents’ reluctance was a major obstacle for returning to school. Therefore, more solidified school reopening strategies should be developed.References:[1]Filocamo G, et al. “Absence of severe complications from SARS-CoV-2 infection in children with rheumatic diseases treated with biologic drugs.” J Rheumatol. 25 avr 2020;[2]Tagarro A, et al. “Screening and Severity of Coronavirus Disease 2019 (COVID-19) in Children in Madrid, Spain.” JAMA Pediatr. 8 avr 2020;[3]Lu X, et al. « SARS-CoV-2 Infection in Children”. N Engl J Med. 23 avr 2020;382(17):1663-5.Acknowledgements:We would like to thank all the participants involved in this clinical research and six medical students who helped completing the forms: Margaux Blondel, Alice Bonnod, Marie Desval, Béatrice Dordain, Gabrielle Fagnet, and Madouc De Saint Martin Pernot.Disclosure of Interests:None declared
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Kirchner, S., C. Sengler, J. Klotsche, I. Liedmann, M. Niewerth, D. Windschall, T. Kallinich, et al. "FRI0591 VALIDITY OF THE GERMAN VERSION OF BOTH THE PARENT ADHERENCE REPORT QUESTIONNAIRE (PARC) AND THE CHILD ADHERENCE REPORT QUESTIONNAIRE (CARQ) - DATA OF THE INCEPTION COHORT OF NEWLY DIAGNOSED PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS (ICON)." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 901.2–901. http://dx.doi.org/10.1136/annrheumdis-2020-eular.4215.
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Background:Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory rheumatic disease in childhood. A multimodal treatment is needed to reduce pain, control inflammation and maintain joint functioning. Adherence to prescribed therapies is necessary for an optimal outcome. Measuring adherence in children with JIA and their caregivers by a validated questionnaire provides important information about benefits and problems with treatment.Objectives:To evaluate adherence in JIA patients and to validate the German version of both the parent adherence report questionnaire (PARQ) and the child adherence report questionnaire (CARQ).Methods:The PARQ and CARQ were translated from its original English version into German and cross-culturally adapted. Parents and children completed the PARQ and CARQ 4 years after enrolment in the Inception cohort ICON. These questionnaires measure child ability (by VAS 0-100, 100 = best) related to i) general level of difficulty in following treatment, ii) frequency of following treatment, iii) negative reactions in response to treatment [i)-iii) summarized to child ability total score], iv) perceived helpfulness of treatment, and 4 categorical questions on errors in medication behavior. Reliability was tested by re-administering the questionnaire after a mean of 13 days. Reproducibility was analysed using intraclass correlation coefficients (ICC). VAS scores were correlated with the Pediatric Quality of Life Inventory (PedsQL) treatment scale items for convergent validity, and with sociodemographic parameters for discriminant validity.Results:481 parents and 465 children completed the PARQ and the CARQ, respectively, 56 parents and 37 children took part in the re-test. The mean age at assessment was 10.1±3.7 years, mean disease duration was 4.7±0.8 years. The majority of patients suffered from oligoarthritis (49%), followed by rheumatoid-factor negative polyarthritis (30%). Treatment with a DMARD received 60% (MTX 46%), 28% received a biological drug, 16% both. Disease activity measured by the clinical juvenile arthritis disease activity score-10 (cJADAS-10) was 2.6 ± 3.4 (range 0 – 30, best = 0), functional status was good (mean CHAQ 0.2 ± 0.4). Exercise and splints were prescribed to 57% and 21% of patients, respectively.PARQ/CARQ mean child ability total scores for medication were 73.1 ± 23.3/76.5 ± 24.2, for exercise: 85.6 ± 16.5/90.3 ± 15.0, for splints: 72.9 ± 24.2/82.9 ± 16.5. About a third of parents and children reported any error in medication behavior. Perceived helpfulness was highest for medication (PARQ/CARQ 87.4 ± 20.6/83.6 ± 26.1) and lowest for splints. (PARQ/CARQ 80.8 ± 28.4/73.5 ± 33.6).ICCs related to medication indicated good to excellent concordance (PARQ ICC = 0.69 - 0.96; CARQ ICC = 0.53 - 0.75), to exercise moderate (PARQ ICC = 0.28 - 0.45; CARQ ICC = 0.67 - 0.93) and to splints disparate concordance (PARQ ICC = 0.01 - 0.90, CARQ ICC = 0.86 - 0.93).Scores for medications (PARQ: r 0.06 - 0.38, CARQ: 0.06 - 0.49), exercise (PARQ: r 0.03 - 0.30, CARQ: 0.01 - 0.34) and splints (PARQ: r 0.09 - 0.52, CARQ: 0.11 - 0.62) showed a fair to good correlation with the PedsQL scales. Gender and socioeconomic status were not associated with the level of adherence.Conclusion:The German version of the PARQ and CARQ appears to be a valuable tool to measure adherence in patients with JIA and to evaluate helpfulness of treatments.Acknowledgments:ICON is funded by the Federal Ministry of Research (FKZ:01ER0812)Disclosure of Interests:Sabine Kirchner: None declared, Claudia Sengler: None declared, Jens Klotsche: None declared, Ina Liedmann: None declared, Martina Niewerth: None declared, Daniel Windschall: None declared, Tilmann Kallinich Grant/research support from: Novartis, Consultant of: Sobi, Roche, Novartis, Gerd Horneff Grant/research support from: AbbVie, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Speakers bureau: AbbVie, Bayer, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Toni Hospach: None declared, Frank Dressler: None declared, J. B. Kuemmerle-Deschner Grant/research support from: Novartis, AbbVie, Sobi, Consultant of: Novartis, AbbVie, Sobi, Kirsten Minden Consultant of: GlaxoSmithKline, Sanofi, Speakers bureau: Roche
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Sommerfleck, F., D. Siri, J. Sole, S. Toloza, J. Velasco, E. Mysler, A. Albarello, et al. "Monoterapia biológica en pacientes con artritis reumatoidea en Argentina." Revista Argentina de Reumatología 24, no. 4 (December 1, 2013): 30–36. http://dx.doi.org/10.47196/rar.v24i4.45.
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Introducción: La utilización de agentes biológicos para el tratamiento de la Artritis Reumatoidea (AR) es habitualmente usada en aquellos pacientes con enfermedad activa que no hayan respondido al tratamiento con drogas modificadoras de la Artritis Reumatoidea convencionales (DMARD, por sus siglas en inglés) o que hayan presentado intolerancia a las mismas. Al estado actual de la evidencia, la terapia combinada de agentes biológicos más un DMARD convencional (principalmente metotrexato) constituye el estándar de tratamiento. Sin embargo existen algunos escenarios como la intolerancia, la falta de adherencia y la aparición de eventos adversos a las DMARDs convencionales donde la monoterapia biológica emerge como una opción terapéutica válida. Según los distintos registros a nivel internacional, la frecuencia de utilización de agentes biológicos en monoterapia oscila entre 12 a 39%. Debido a la ausencia de estos datos a nivel local decidimos realizar este estudio para conocer el porcentaje de pacientes que se encuentran en monoterapia biológica y analizar las causas que llevaron a este tipo de tratamiento. Materiales y métodos: Estudio de tipo corte transversal donde se invitó a participar a diferentes centros reumatológicos distribuidos a lo largo de Argentina. Cada centro revisó las historias clínicas de los últimos 30 a 50 pacientes consecutivos vistos con AR, mayores de 18 años, que habían presentado inadecuada respuesta al tratamiento con DMARDs y que estaban bajo tratamiento biológico. Se completaba una ficha por cada paciente incluido, registrando datos demográficos, de la enfermedad y tratamientos previos. Resultados: Se incluyeron 32 centros y se evaluaron 1148 historias clínicas de pacientes con AR durante el mes de octubre y noviembre del 2012. Un 21,4% (246) de los pacientes al momento del estudio se encontraba bajo tratamiento biológico en monoterapia. Las razones de la selección del tratamiento monoterapia fueron: 45% evento adverso, 35% decisión del médico por buena evolución del paciente, 13% decisión del paciente, 7% inadecuada respuesta a las DMARDs. Los eventos adversos que llevaron al uso de monoterapia fueron: 31,9% hepatotoxicidad, 21,6% intolerancia gástrica, 9,6% estomatitis, 7,4% cefalea, 5,3% caída del cabello, entre los más frecuentes. En relación al tratamiento en combinación, el MTX fue la DMARD más utilizada (69%). Los médicos referían en un 98% de los casos estar satisfechos de la respuesta terapéutica bajo el tratamiento biológico como monoterapia. Conclusión: Una proporción significativa de pacientes con AR están siendo tratados con agentes biológicos en monoterapia. Las principales causas de esta opción terapéutica fueron intolerancia a la DMARD y decisión de discontinuación del DMARD debido a buena evolución del paciente.
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Baldivieso, J. P., E. Ramirez, M. Uriarte-Ecenarro, C. Valero, E. Velasco, I. Llorente, A. Morell, O. Solas, and R. Garcia-Vicuna. "AB1185 PATIENT-REPORTED EXPERIENCE IN IMMUNE MEDIATED INFLAMMATORY DISEASES (IMID) IN THECONTEXT OF THE COVID-19 PANDEMIC: ACCESSIBILITY AND CONTINUITY OF CARE." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 1707.1–1707. http://dx.doi.org/10.1136/annrheumdis-2022-eular.5203.
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BackgroundThe lockdown and mobility restrictions in early COVID19 pandemic had a great impact in chronic patient care due to limited access and scheduled visits. In our hospital, coordinated non-pharmacological interventions (NPI) were designed in Rheumatology and Pharmacy services to maintain the accessibility and continuity of care for patients with IMID.ObjectivesTo evaluate the patient reported experience (PRE), health status and quality of life in Rheumatology outpatient IMID subjects since March 14, 2020 when lockdown was imposed and during subsequent restrictions, related to the healthcare team and medications accessibility, and continuity of care.MethodsObservational study, using a patient survey. Adult patients attending the rheumatology outpatient clinic between Nov 2, 2020 to Feb 13, 2021, with rheumatoid arthritis (RA), psoriatic arthritis (PsA), spondylarthritis (SpA) or systemic autoimmune diseases (SAD), with at least 1 year from diagnosis and 1 month of treatment with conventional synthetic (cs) targeted synthetic (ts) or biological (b) disease modifying antirheumatic drugs (DMARD). Face to face or phone interviews were conducted using an ad hoc designed questionnaire that included COVID19 related questions, the 11 IEXPAC scale items (5 point Likert scale ranging from never to always) (www.iexpac.org), and 4 items (5 points, very good to very bad) of the global scale PROMIS 10 (Patient-Reported Outcomes, PRO). All questions refer to the patient’s experience during the 6 months prior to data collection.ResultsFrom 174 screening patients, 158 completed the survey, mainly woman (66.5%) with a median age of 60 (IQR 47-69,3) years. The most frequent diagnosis was RA (43%) followed by ESAP (35%), EAS (22%) and PsA (13%). 46.8% of the patients have been prescribed b or ts DMARD and 53.2% sc DMARD, 32.9% in combination. From 158, 39 persons requested healthcare for COVID-19 related symptoms and diagnosis was confirmed in 17 (10,8%). Just 2 patients required hospital admission. Clinical control and continuity of care for COVID19+ patients were carried out from their primary care center and by phone consultation. Some key results of the survey are displayed in Table 1.Table 1.PRO and Patients’ perception during COVID19 lockdown and restrictions.During confinement and restrictions due to covid-19, in the last 6 months …Responses (%)N= 158Your degree of concern about the COVID19 crisis is.High + Quite high (86.7)PRO (PROMIS 10)How good was your health …?Very good (11.4), Good: (43.7)and your emotional/mental health, including mood and ability to think?Very good (10.1)Good (41.1)your quality of life was.Very good (8.25) Good (49,4)Your satisfaction in performing daily tasks (home, work, family) was.Very good (7.8)Good (55.1)Accessibility to care and medicationsI could contact my rheumatologist whenever I needed (email, phone).Always (79.9)My rheumatologist changed my face-to-face visit for a phone callYes (53)I received my medication at home from the hospital pharmacyYes (16)I picked up my medication from the hospital pharmacy, without incident.Yes (21)I maintained the prescribed dose medication…Always + almost always (96,2)At some point I modify a medication by my own decisionYes (6)My doctor changed the dose or route of administrationYes (7)Your satisfaction with the care provided from all professionals in the team wasVery + Quite satisfied (75)PREMS (IEXPAC)Item 2. The professionals … are coordinated to offer me good healthcareAlways (34.18)Item 8. They make sure that I take my medication correctlyAlways (73.42)Item 9. They worry about my welfareAlways (74.68)ConclusionLessons have learned during the COVID19 lockdown and restrictions by assessing patients’ health status and patients-reported experience. Coordinated NPI such as medication monitoring and home delivery, appointment reorganization and protocolized phone visits can result in a good patient perception and medication adherence whilst receiving care in a challenging situation.Disclosure of InterestsNone declared
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Rantalaiho, Vappu, Hannu Kautiainen, Markku Korpela, Kari Puolakka, Harri Blåfield, Kirsti Ilva, Pekka Hannonen, Marjatta Leirisalo-Repo, and Timo Möttönen. "Physicians' adherence to tight control treatment strategy and combination DMARD therapy are additively important for reaching remission and maintaining working ability in early rheumatoid arthritis: a subanalysis of the FIN-RACo trial." Annals of the Rheumatic Diseases 73, no. 4 (December 2, 2013): 788–90. http://dx.doi.org/10.1136/annrheumdis-2013-204271.
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Holdsworth, E., R. Lukanova, M. Hughes, J. Hall, J. Austin, G. Taylor-Stokes, and J. Piercy. "POS1205 THE IMPACT OF COVID-19 ON PATIENT MANAGEMENT AND PRESCRIBING STRATEGY ACROSS THE EU AND US: A REAL-WORLD SURVEY OF RHEUMATOLOGISTS, DERMATOLOGISTS, AND GASTROENTEROLOGISTS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 885.1–885. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2103.
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Background:The COVID-19 pandemic is expected to have impacted patient management on a global level. However, the degree of impact on patient management and prescribing strategy in the fields of rheumatology, dermatology and gastroenterology is unclear.Objectives:Assess the impact of COVID-19 on patient management and prescribing strategy across the EU and US, as described by rheumatologists, dermatologists, and gastroenterologists.Methods:Data were drawn from physician surveys in France, Germany, Italy, Spain, UK and US between July and December 2020. Physicians completed an online or telephone survey assessing how COVID-19 has impacted type and frequency of consultations; choice and prescription of medication.Results:847 physicians took part; 355 rheumatologists, 200 dermatologists (Germany, Spain, UK, and US only), and 282 gastroenterologists. As a result of COVID-19, most physicians stated they have moved at least some patients to video or telephone consultations (70% rheumatologists; 55% dermatologists; 60% gastroenterologists) and reduced overall frequency of consultations with patients (59% rheumatologists; 64% dermatologists; 51% gastroenterologists) (Table 1).35% of rheumatologists, 22% of dermatologists, and 14% of gastroenterologists described COVID-19 as changing the way they choose and prescribe medication, with differences observed between countries (Figure 1). Of those who stated they have made medication changes, rheumatologists stated changing medication to self-administration (62%) and not starting new patients on an advanced therapy (biologic DMARD or targeted synthetic DMARD) (58%) as most frequent. Dermatologists stated changes include changing treatment to more COVID-appropriate treatment (71%) and prescribing repeat prescriptions more regularly without consultation (56%). Gastroenterologists stated changes include changing medication to self-administration (55%) and prescribing a longer course of medication (48%).Comparing across countries, for all specialties, the greatest changes were observed in the UK followed by Spain, with least changes in Germany and Italy.Conclusion:There have been changes in the process of how healthcare is delivered, although treatment prescription was impacted to a lesser extent than consultation type and frequency. This varies across geographies, which may be due to differences in reported prevalence of COVID-19. Differences are also observed across specialities, which may be due to guidance received from specialty bodies. It is unknown what the long-term impact of changes in the management of patients due to COVID-19 will be on patient outcomes, satisfaction, engagement and adherence, and further research is needed.Table 1.Rheumatologist, Dermatologist, and Gastroenterologist described impact on patient management, by countryGlobal(n=847)France(n=90)Germany(n=168)Italy(n=122)Spain(n=161)UK(n=133)US(n=163)Rheumatologistsn=365n=50n=58n=59n=57n=50n=81Moving to video/telephone consultation70%70% 36%47%86%94%84%Fewer visits for individual patients (reduced visiting schedule)59%80%0%41%96%76%65%Dermatologistsn=200-n=50-n=50n=50n=50Moving to video/telephone consultation55%-40%-58%66%56%Fewer visits for individual patients (reduced visiting schedule)64%-60%-54%72%72%Gastroenterologistsn=282n=40n=60n=63n=54n=33n=32Moving to video/telephone consultation60%63%18%54%83%100%69%Fewer visits for individual patients (reduced visiting schedule)51%35%43%51%43%79%69%Figure 1.Proportion of rheumatologists, dermatologists, and gastroenterologists reporting changing the way they choose and prescribe medication as a result of COVID-19Disclosure of Interests:None declared.
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Sena, A. G., D. Granados, N. Hughes, W. Fakhouri, A. Hottgenroth, R. Kolde, S. Reisberg, et al. "THU0212 FIRST LINE TREATMENT WITH CONVENTIONAL SYNTHETIC DISEASE MODIFYING ANTIRHEUMATIC DRUGS IN RHEUMATOID ARTHRITIS: A MULTINATIONAL POPULATION-BASED COHORT FROM 14 REAL WORLD HEALTHCARE DATABASES AND 9 COUNTRIES - REALITY VERSUS GUIDELINES." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 331.1–331. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3131.
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Background:Treatment guidelines recommend early initiation of csDMARDs following diagnosis of rheumatoid arthritis (RA), with methotrexate (MTX) as first-line therapy. Scarce evidence exists on adherence to this guidanceObjectives:To characterize first-line csDMARD treatment during the first year following an RA diagnosis.Methods:14 real world databases (3 Primary care, 6 primary/secondary care records, 5 claims) from 9 countries were included, all mapped to the OMOP common data model.Patients were included on the earliest event of: 1st diagnosis of RA or 1st DMARD prescription with an RA diagnosis within 30 days. Patients were >18 years-old, required 1+ year pre-index data, and at least 1-year follow-up. Study period covered 2000-2018. Previous users of DMARDs or non-RA inflammatory arthritis history were excluded. Only MTX, Hydroxychloroquine (HCQ), Sulfasalazine (SSZ) and Leflunomide (LEF) were available in all databases.Results:We identified 323,547 eligible participants. Large variation was observed internationally (Figure 1). MTX as first-line monotherapy ranged from 33.3% to 74.5%, and in combination with HCQ from 2.1% to 6.7%. Three additional csDMARDs were used as first-line: HCQ in 10.1% to 30.2%, SSZ in 0.9% to 28.7%, and LEF in 1.8% to 15.2%.Figure 1.First line csDMARD treatment during 1yr from first observed RA diagnosisConclusion:We report wide heterogeneity of first-line csDMARDs regimens internationally. Despite recommendations for MTX to be first line therapy, data suggest that a large proportion of patients receive alternative csDMARD.Disclosure of Interests: :Anthony G Sena Shareholder of: J&J shares, Grant/research support from: Full-time employment salary from Janssen, Consultant of: Full-time employment salary from Janssen, Employee of: Janssen employee, Paid instructor for: Janssen employee, Speakers bureau: Janssen employee, Denis Granados: None declared, Nigel Hughes Shareholder of: J&J shares, Grant/research support from: Full-time employment salary from Janssen, Consultant of: Janssen employee, Employee of: Janssen employee, Paid instructor for: Janssen employee, Speakers bureau: Janssen employee, WALID FAKHOURI Shareholder of: E Lilly Shares, Employee of: Eli Lilly and Company, Antje Hottgenroth Shareholder of: Eli Lilly shares, Employee of: Lilly Deutschland GmbH, Raivo Kolde: None declared, Sulev Reisberg: None declared, Carmen Olga Torre: None declared, Talita Duarte-Salles: None declared, Yesika Díaz: None declared, Jose Felipe Golib-Dzib Grant/research support from: Full-time employment salary from Janssen, Employee of: Yes, Janssen employee, Paid instructor for: Janssen Employee, Speakers bureau: Janssen Employee, Emily S. Brouwer Shareholder of: J&J shares, Takeda shares, Grant/research support from: Full-time employment salary from Janssen, Consultant of: Janssen employee, Employee of: Janssen employee, Paid instructor for: Janssen Employee, Speakers bureau: Janssen Employee, Edward Burn: None declared, Jennifer Lane: None declared, David Vizcaya Employee of: Bayer, Sara Bruce Wirta Employee of: Janssen-Cilag Sweden AB, Marcel de Wilde: None declared, Katia Verhamme: None declared, Peter Rijnbeek: None declared, Elke Theander Employee of: Janssen-Cilag Sweden AB, Katerina Chatzidionysiou Consultant of: AbbVie, Pfizer, Lilly., Daniel Prieto-Alhambra Grant/research support from: Professor Prieto-Alhambra has received research Grants from AMGEN, UCB Biopharma and Les Laboratoires Servier, Consultant of: DPA’s department has received fees for consultancy services from UCB Biopharma, Speakers bureau: DPA’s department has received fees for speaker and advisory board membership services from Amgen, Patrick Ryan: None declared
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Natalello, G., E. De Lorenzis, G. Tanti, P. Rubortone, M. R. Magurano, G. Peluso, and E. Gremese. "SAT0405 CLINICAL AND PSYCHOLOGICAL PREDICTORS OF GASTROINTESTINAL INTOLERANCE TO METHOTREXATE IN PATIENTS WITH PSORIATIC ARTHRITIS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1154.2–1155. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2560.
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Background:Methotrexate (MTX) is a first-line treatment for psoriatic arthritis (PsA). Gastrointestinal intolerance (GI) to the drug is a common adverse event that limits its use and can be mediated by autonomic dysfunction or classical conditioning phenomena to repeated drug exposure. Anxiety and depression could promote these processes.Objectives:To assess the prevalence of GI to MTX and its association with anxiety and depression in PsA patients.Methods:One hundred unselected PsA patients in stable MTX treatment were characterized by disease characteristics, adherence to treatment by Morisky Medication Adherence Scale (MMAS-8) and comorbidity by Rheumatic Disease Comorbidity Index (RDCI). Depressive and anxious symptoms were assessed by Hospital Anxiety and Depression Scale (HADS). The presence and the severity of nausea, vomiting, abdominal pain and diarrhoea after administration (associative symptoms) and just before or even at the thought of taking MTX (anticipatory symptoms) were recorded.Results:Patients had a mean age of 56.9±12.0 years and a disease duration of 9.5 years (0.1-58.0 years). They were male, smokers and overweight in 40.0%, 20.0% and 65.0% of cases, respectively. The prevalence of both significant anxious and depressive symptoms was 42.0%. DAPSA showed remission, low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA) in 24.0%, 41.0%, 32.0% and 3.0% of patients, respectively. MTX was taken orally by 15.0% of patients and associated with another conventional or biological DMARD in 14.0% and 35.0% of cases, respectively. Symptoms of GI to MTX were complained by 69.3% of patients. Specifically, the prevalence of nausea, diarrhea, vomiting and abdominal pain was 59.0%, 23.0%, 21.0% and 30.0% with associative pattern and 43.0%, 12.0%, 10.0% and 16.0% with anticipatory pattern, respectively. Patients with anxious symptoms experienced more frequently moderate to severe associative nausea (71.4% vs 50.0%, p=0.032) and abdominal pain (42.9% vs 20.7%, p=0.017), and anticipatory nausea (42.9% vs 19.0%, p=0.009), vomiting (14.3% vs 6.9%,p=0.046), and abdominal pain (26.2% vs 8.6%, p=0.018) than non-anxious patients. Patients with depressive symptoms more commonly had associative diarrhea (33.0% vs 15.5%, p=0.037), with no difference in the prevalence of anticipatory symptoms. The presence of associative and anticipatory nausea was associated with higher anxiety scores (p=0.006 and p=0.02 respectively) without differences in the depression score. Associative nausea characterized younger patients (p=0.001), female (p=0.02), with lower BMI (p=0.02) and treated with higher MTX doses (p=0.05). Anticipatory nausea was associated with a lower age (p=0.02), a lower BMI (p=0.005), a longer disease duration (p=0.028), a lower DAPSA (p=0.02), an higher MTX doses (p=0.02) and a lower comorbidity burden (p=0.03). The anticipatory and associative nausea determined lower compliance according to MMAS-8 (p=0.007 and p=0.001, respectively). An anxious profile characterized patients with moderate to severe associative nausea also in the logistic regression model corrected for age (≥65 years), gender, BMI (≥25 kg/m2) and MTX dose (≥0.2mg/kg/week) (OR 3.0, IC 1.1-8.4, p=0.036), and patients with anticipatory nausea also in the model corrected for age (≥65 years), gender, BMI (≥25 kg/m2) and MTX dose (≥0.2mg/kg/week) and disease duration (≥6 years) (OR 3.0, IC 1.1-8.0,p=0.027).Conclusion:Up to two-thirds of patients with PsA who have been treated with MTX experienced symptoms of GI, leading to reduced therapeutic adherence. Associative and anticipatory symptoms characterize patients with a specific clinical and psychological profile.Disclosure of Interests:Gerlando Natalello: None declared, Enrico De Lorenzis: None declared, Giacomo Tanti: None declared, Pietro Rubortone: None declared, Maria Rosaria Magurano: None declared, Giusy Peluso: None declared, Elisa Gremese Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp & Dohme, Novartis, Sanofi, UCB, Roche, Pfizer
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Bottois, C., C. López-Medina, S. Dumas, H. Julien, B. Sephora, C. Roux, A. Moltó, O. Conort, and M. Dougados. "POS0273-HPR PHARMACIST’S IMPACT ON SELF-MANAGEMENT FOR PATIENTS WITH CHRONIC INFLAMMATORY ARTHRITIS TREATED WITH BIOLOGICAL DMARDS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 360.2–360. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2135.
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Background:Knowledge about chronic inflammatory rheumatisc diseases and skills to administer and manage subcutaneous (subcut) biological DMARDs (bDMARDs) are key aspects to optimize patient’s self-management. Intervention of several successive health professionals (e.g comprehensive multidisciplinary team) has proven to be an effective method to improve patient’s self-management of their disease and treatment.Objectives:To assess the pharmacist’s impact on patient’s knowledge and skills during a multidisciplinary annual review. The secondary objectives were to assess this impact on therapeutic adherence and patient’s satisfaction as well as to determine the factors associated with the level of knowledge at baseline.Methods:Study type: prospective, monocentric, 6 months-follow-up, non-controlled study approved by Local Ethical Committee. Inclusion criteria: patient with either rheumatoid arthritis (RA) or spondyloarthritis (SpA), and treated with subcut bDMARDs. Intervention: The visit with a pharmacist evaluating and discussing patient’s knowledge and treatment adherence. At baseline (M0): date of the visit and, 3 (M3) and 6 months (M6) later, knowledge and adherence were assessed using self-administered questionnaires: Biosecure and CQR-5 respectively. A questionnaire was sent at M3 in order to evaluate the patient satisfaction. Endpoints: Primary: Changes in Biosecure score Secondary: Percentage of patients with high level of knowledge (score > 84) and percentage of patients with high adherence at M3 and M6; patient’s satisfaction; identification of patient’s factors (socio-demographics, rheumatisc disease treatments) associated with different levels of knowledge at baseline.Statistical analysis: repeated measures ANOVA, Bonferroni and Generalized Estimating Equation, univariate and multivariate linear regression.Results:The study was conducted from October 2019 to July 2020; 79 patients were included (age (years) = 50±15; sex ratio = 1.1; RA=25, SpA=54). The Biosecure scores changed from 71±18 to 82±15 (M3) and to 84±14 (M6) (p<0.001). At M0, M3 and M6, the rate of patients with a high level of knowledge was 24.1%, 59.5% and 63.3% respectively (p<0.001). No difference was observed for the change in the 92% of patients considered as high adherent (92% versus 95% at M0 and M6 respectively; p=0.077). Patient’s satisfaction regarding the pharmaceutical intervention was 25±3 (max = 28).Factors associated with a better Biosecure score in the multivariate analysis were the following, lifestyle as a couple (p<0.001), information given by a nurse (p=0.033), information searched for on patient associations (p=0.013) and a low Charlson score (p=0.001)Conclusion:Pharmacist’s intervention in the comprehensive multidisciplinary annual review resulted in a beneficial impact on patients’ knowledge and skills to manage their bDMARDs with a high level of satisfaction from a patient perspective.Disclosure of Interests:None declared
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Molteni, E., F. Ceccarelli, C. Castellani, F. Giardina, C. Alessandri, M. DI Franco, V. Riccieri, et al. "AB0234 SURVIVAL OF ABATACEPT IN RHEUMATOID ARTHRITIS PATIENTS: A REAL-LIFE STUDY." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 1143.1–1143. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3689.
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Background:Abatacept (ABA) is a biological drug approved for the treatment of rheumatoid arthritis (RA) patients that, by working on CTLA4, can inhibit T-cell activation. Randomized controlled trials have demonstrated both the efficacy and a good safety profile, characterized by a lower infectious risk in comparison with other biological DMARDs, in RA patients. In a real-life setting, the drug retention rate could be considered as a surrogate of drug effectiveness. Data from the literature reported a retention rate of ABA ranging from 55 to 76% at 12 months and from 54 to 64% at 24 months (1-3).Objectives:In the present longitudinal analysis, we evaluated the retention rate of ABA in a large monocentric RA cohort.Methods:We enrolled consecutive RA patients starting treatment with intravenous (IV) or subcutaneous (SC) ABA according to the standard of care. All the patients fulfilled the 2010 ACR/EULAR classification criteria for RA. For each patient, we collected demographic parameters, serological status, previous and concomitant treatments, and disease activity by DAS28 with C reactive protein (DAS28-CRP). All the patients were assessed at baseline, and after 4 and 12 months (T4 and T12, respectively). The reasons for withdrawal of treatment were registered and classified as primary or secondary inefficacy or adverse events (AEs). Kaplan-Meier statistical analysis has been done to evaluate the survival of the treatment in patients with at least 12 months follow-up.Results:We evaluated 161 patients [M/F 21/140; median age 67 years (IQR 21.7), median disease duration 180 months (IQR 161)]. RF was positive in 70.3% of patients, ACPA in 66.4%. ABA was the first biological DMARD in 66 patients (41%). At baseline, the median DAS28-CRP was 4.3 (IQR 1.6) and ABA was administered in association with MTX in 96 patients (59.6%). One hundred-eleven patients (68.9%) started SC ABA [M/F 16/95; median age 64.5 years (IQR 21.5), median disease duration 156 months (IQR 132)], the remaining 50 IV ABA [M/F 5/45, median age 71 years (IQR 60.2), median disease duration 187 months (IQR 157)]. Median age and disease duration were significantly higher in patients receiving IV in comparison with SC ABA (p=0.008 and p=0.03, respectively). We found a significant reduction of DAS28-CRP values during the follow-up in comparison with baseline [4 months: median 3.5 (IQR 1.9), p<0.0001; 12 months: median 3.2 (IQR 1.4), p<0.0001]. Seven patients were lost to follow-up, in the remaining 154 patients a median treatment duration of 33 months (IQR 49) was registered. Data on drug survival are reported in Figure 1A: at 12 months, 92% of patients persisted on treatment; this percentage decreased to 78.2% at 24 months and to 67.9% at 36 months. Furthermore, we did not find any differences in drug survival either with respect to SC vs IV administration (12 months: 93.7% versus 88.6%; 24 months 78.9% versus 72.6%; 36 months 63.7% versus 72.6%; Figure 1B) or according to the association with MTX. Concerning the withdrawal reasons, 46 patients (29.9%) stopped ABA due to inefficacy (primary in 28, secondary in 18), 11 patients (7.1%) due to AEs, and 7 for inadequate adherence (4.5%). Finally, 10 patients switched from IV to SC administration, due to patient’s preference.Conclusion:In our monocentric RA cohort, we have observed a high retention rate of ABA at both 12 and 24 months, confirming the good profile of this drug in terms of effectiveness and safety, irrespective of the route of administration and association with MTX.References:[1]Cagnotto, Arthritis Res Ther 2020; (2) Salmon, J Clin Med 2020; Westhovens, Rheumatol Int 2020.Acknowledgements:I would like to acknowledge Dr. F. Ceccarelli, for her patience.Disclosure of Interests:None declared
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Russell, O., S. Lester, R. Black, and C. Hill. "AB0142 SOCIOECONOMIC STATUS (SES) AND MEDICATION USE IN RHEUMATOID ARTHRITIS (RA): A SCOPING REVIEW." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 1098.2–1099. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3439.
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Background:Socioeconomic status (SES) influences disease outcomes in rheumatoid arthritis (RA) patients. (1, 2) Differences in medication use could partly explain this association. (3) A scoping review was used to identify research conducted on this topic and determine what knowledge gaps remain.Objectives:To determine what research has been conducted on this topic, how this research has defined SES and medication use, and establish what knowledge gaps remain.Methods:MEDLINE, EMBASE and PsychInfo were searched from their inception until May 2019 for studies which assessed SES and medication use as outcome variables. Studies were included if they measured medication use and incorporated an SES measure as a comparator variable.SES was defined using any of the “PROGRESS” framework variables (4) including patients’ stated gender, age, educational attainment, employment, occupational class, personal income, marital status, health insurance coverage, area- (neighbourhood) level SES, or patients’ stated race and/or ethnicity. Medication use was broadly defined as either prescription or dispensation of a medicine, medication adherence, or delays in treatment. Data was extracted on studies’ primary objectives, measurement of specific SES measures, patients’ medication use, and whether studies assessed for differences in patients’ medication use according to SES variables.Results:1464 studies were identified by this search from which 74 studies were selected for inclusion, including 52 published articles. Studies’ publication year ranged from 1994-2019, and originated from 20 countries; most commonly from the USA.Studies measured a median of 4 SES variables (IQR 3-6), with educational achievement, area level SES and race/ethnicity the most frequently recorded.Likelihood of disease modifying antirheumatic drug (DMARD) prescription was the most frequent primary objective recorded.96% of studies reported on patients’ use of DMARDs, with glucocorticoids and analgesics being reported in fewer studies (51% and 23% respectively.)Most included studies found at least one SES measure to be significantly associated with differences in patients’ medication use. In some studies, however, this result was not necessarily drawn from the primary outcome and therefore may not have been adjusted for covariates.70% of published studies measuring patients’ income (n=14 of 20) and 58% of those that measured race/ethnicity (n=14 of 24) documented significant differences in patients’ medication use according to these SES variables, although the direction of this effect – whether it led to ‘greater’ or ‘lesser’ medication use – varied between studies.Conclusion:Multiple definitions of SES are used in studies of medication use in RA patients. Despite this, most identified studies found evidence of a difference in medication use by patient groups that differed by an SES variable, although how medication use differed was found to vary between studies. This latter observation may relate to contextual factors pertaining to differences in countries’ healthcare systems. Further prospective studies with clearly defined SES and medication use measures may help confirm the apparent association between SES and differences in medication use.References:[1]Jacobi CE, Mol GD, Boshuizen HC, Rupp I, Dinant HJ, Van Den Bos GA. Impact of socioeconomic status on the course of rheumatoid arthritis and on related use of health care services. Arthritis Rheum. 2003;49(4):567-73.[2]ERAS Study Group. Socioeconomic deprivation and rheumatoid disease: what lessons for the health service? ERAS Study Group. Early Rheumatoid Arthritis Study. Annals of the rheumatic diseases. 2000;59(10):794-9.[3]Verstappen SMM. The impact of socio-economic status in rheumatoid arthritis. Rheumatology (Oxford). 2017;56(7):1051-2.[4]O’Neill J, Tabish H, Welch V, Petticrew M, Pottie K, Clarke M, et al. Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. J Clin Epidemiol. 2014;67(1):56-64.Acknowledgements:This research was supported by an Australian Government Research Training Program Scholarship.Disclosure of Interests:None declared