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Sood A, Kuo YF, Westra J, Raji MA. Disease-Modifying Antirheumatic Drug Use and Its Effect on Long-term Opioid Use in Patients With Rheumatoid Arthritis. J Clin Rheumatol 2023; 29:262-267. [PMID: 37092898 PMCID: PMC10545291 DOI: 10.1097/rhu.0000000000001972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND/OBJECTIVES The prevalence of chronic pain is high in patients with rheumatoid arthritis (RA), increasing the risk for opioid use. The objective of this study was to assess disease-modifying antirheumatic drug (DMARD) use and its effect on long-term opioid use in patients with RA. METHODS This cohort study included Medicare beneficiaries with diagnosis of RA who received at least 30-day consecutive prescription of opioids in 2017 (n = 23,608). The patients were grouped into non-DMARD and DMARD users, who were further subdivided into regimens set forth by the American College of Rheumatology. The outcome measured was long-term opioid use in 2018 defined as at least 90-day consecutive prescription of opioids. Dose and duration of opioid use were also assessed. A multivariable model identifying factors associated with non-DMARD use was also performed. RESULTS Compared with non-DMARD users, the odds of long-term opioid use were significantly lower among DMARD users (odds ratio, 0.89; 95% confidence interval, 0.83-0.95). All regimens except non-tumor necrosis factor biologic + methotrexate were associated with lower odds of long-term opioid use relative to non-DMARD users. The mean total morphine milligram equivalent, morphine milligram equivalent per day, and total days of opioid use were lower among DMARD users compared with non-DMARD users. Older age, male sex, Black race, psychiatric and medical comorbidities, and not being seen by a rheumatologist were significantly associated with non-DMARD use. CONCLUSION Disease-modifying antirheumatic drug use was associated with lower odds of long-term opioid use among RA patients with baseline opioid prescription. Factors associated with non-DMARD use represent a window of opportunity for intervention to improve pain-related quality of life in patients living with RA.
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Affiliation(s)
- Akhil Sood
- Division of Immunology & Rheumatology, Stanford University School of Medicine, Palo Alto, CA 94304
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Yong-Fang Kuo
- Department of Preventive Medicine & Population Health, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Jordan Westra
- Department of Preventive Medicine & Population Health, University of Texas Medical Branch, Galveston, TX, 77555-01777
| | - Mukaila A. Raji
- Department of Geriatric Medicine, University of Texas Medical Branch, Galveston, TX, 77555-01777
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2
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Russell O, Lester S, Black RJ, Hill CL. Socioeconomic Status and Medication Use in Rheumatoid Arthritis: A Scoping Review. Arthritis Care Res (Hoboken) 2023; 75:92-100. [PMID: 36106932 PMCID: PMC10100498 DOI: 10.1002/acr.25024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/22/2022] [Accepted: 09/13/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Socioeconomic status (SES) influences disease outcomes in rheumatoid arthritis (RA) patients. Differences in medication use may partly explain this association. A scoping review was used to identify research conducted on this topic and determine what knowledge gaps remain. METHODS Medline, Embase, and PsychInfo were searched from their inception until February 2022 for studies that assessed SES and medication use as an outcome variable. Data was extracted on the use of specific SES measures, medication use, and whether differences in SES variables were associated with differences in medication use. RESULTS We identified 2,103 studies, of which 81 were selected for inclusion. Included studies originated most frequently from the US (42%); the mean ± SD age of participants was 55.9 ± 6.8 years, and most were female (75%). Studies measured a median of 4 SES variables (interquartile range 3-6), with educational, area-level SES, and income being the most frequent measurements used. Patients' race and/or ethnicity were documented by 34 studies. Studies primarily assessed the likelihood of prescription of disease-modifying antirheumatic drugs or dispensation, medication adherence, or treatment delays. A majority of studies documented at least 1 SES measure associated with a difference in medication use. CONCLUSION There is some evidence that SES affects use of medications in patients with RA; however, multiple definitions of SES have been utilized, making comparisons between studies difficult. Prospective studies with consistently defined SES will be needed to determine whether differences in medication use accounts for the poorer outcomes experienced by patients of lower SES.
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Affiliation(s)
- Oscar Russell
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia, and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Susan Lester
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia, and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rachel J Black
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia, and Adelaide Medical School, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Catherine L Hill
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia, and Adelaide Medical School, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
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3
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Sherman BW, Sils B, Kamin L, Westrich K. Specialty drug and health care utilization vary by wage level in employer-sponsored health plans. J Manag Care Spec Pharm 2022; 28:918-928. [DOI: 10.18553/jmcp.2022.22091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Bruce W Sherman
- School of Medicine, Case Western Reserve University, Cleveland, OH
- National Alliance of Healthcare Purchaser Coalitions, Washington, DC
| | - Brian Sils
- National Pharmaceutical Council, Washington, DC
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4
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Loyola-Sanchez A, Hazlewood G, Crowshoe L, Linkert T, Hull PM, Marshall D, Barnabe C. Qualitative Study of Treatment Preferences for Rheumatoid Arthritis and Pharmacotherapy Acceptance: Indigenous Patient Perspectives. Arthritis Care Res (Hoboken) 2020; 72:544-552. [PMID: 30821924 PMCID: PMC7187260 DOI: 10.1002/acr.23869] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 02/26/2019] [Indexed: 12/12/2022]
Abstract
Objective To explore patient preferences that influence decision‐making in the management of rheumatoid arthritis (RA) by indigenous patients living in southern Alberta, Canada. Methods We conducted a qualitative narrative‐based study within a social constructivist framework. Thirteen in‐depth interviews with indigenous patients with RA who had attended 1 of 3 rheumatology practices in southern Alberta (1 rural and 2 urban) were completed. Codes generated through 2 phases of analysis were condensed into main themes, triangulated, and used to produce theoretical statements. Results Patients preferred to use a combination of nonpharmacologic and pharmacologic treatments to manage their RA. Nonpharmacologic treatments included physical, mental, emotional, and spiritual strategies. Patients’ preferences for taking medications varied and were influenced by factors that were clinical (i.e., trust in health providers and understanding drugs’ mechanisms of action, benefits, harms, and administration burden), familial (i.e., support), and societal (i.e., access to medications and stigmatization of drug dependency). Conclusion Indigenous patients apply a holistic approach to the nonpharmacologic management of RA. Increases in preferences for RA medications could be supported through enhanced communication strategies to increase patient understanding of medication effects and health provider recognition of societal and familial influences on patient decisions. A patient–provider relationship based on trust was fundamental to reaching mutual understanding and should be fostered by models of practice that promote cultural safety, empathy, compassion, openness, acknowledgment, and respect of cultural differences.
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Affiliation(s)
| | - Glen Hazlewood
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lynden Crowshoe
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tessa Linkert
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pauline M Hull
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah Marshall
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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5
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Boytsov NN, Bhattacharya R, Saverno K, Dixon L, Abbott PL, Zhang X, Gaich CL, Nair R. Health Care Effect of Disease-Modifying Antirheumatic Drug Use on Patients with Rheumatoid Arthritis. J Manag Care Spec Pharm 2019; 25:879-887. [PMID: 31347977 PMCID: PMC10398047 DOI: 10.18553/jmcp.2019.25.8.879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Disease-modifying antirheumatic drugs (DMARDs) are recommended as the standard of care for patients with rheumatoid arthritis (RA) due to their ability to reduce pain and disability; however, DMARD use is low in some subgroups of the RA population. OBJECTIVE To identify characteristics associated with DMARD use in the overall cohort of patients with RA and newly diagnosed RA patients. METHODS This retrospective observational study used claims from a large national health plan. Use of DMARDs was measured according to the Healthcare Effectiveness Data and Information Set (HEDIS) as the proportion of patients with RA receiving DMARDs. Following HEDIS measure technical specifications, we identified patients aged 18-89 years with continuous enrollment during 2014 (measurement year) with ≥ 2 claims for RA outpatient visits and/or discharges on different dates between January and November 2014. Additionally, we identified a subset of patients newly diagnosed with RA in 2014 based on absence of any claims for RA or DMARDs in 2013. Descriptive analyses and bivariate associations were used to compare demographic and clinical characteristics of patients with RA with or without DMARD use in 2014. Health care resource utilization (HCRU) and costs were compared in 2014 for patients enrolled in Medicare Advantage Prescription Drug (MAPD) plans during both 2014 and 2015. Regression models were used to evaluate patient and provider characteristics associated with DMARD use in 2014 and the effect on HCRU and costs. RESULTS Among the 33,880 patients identified with RA in 2014, most patients received a DMARD (75.2%); 29.4% of patients newly diagnosed with RA had been treated with DMARDs in 2014. Patients with DMARD use, on average, were younger (aged 67 years ± 10.7 vs. 69 years ± 10.7) and healthier (Deyo-Charlson Comorbidity Index [DCCI] 2.4 ± 1.9 vs. 2.6 ± 2.1) and included a greater proportion of women (75.9% vs. 71.0%) than those with no DMARD use (P < 0.0001). Use of DMARDs (P < 0.0001) was associated with 14.5% fewer hospitalizations and 18.0% fewer emergency department visits. Although total costs increased by 15.0% with use of DMARDs, when the cost of DMARDs was excluded, the total cost decreased by 13.7% (P < 0.0001). Female gender (32.2%), higher claims-based index for RA severity score (47.0%), higher RxRisk-V score (26.7%), visit to a rheumatologist (34.3%), and use of glucocorticoids (17.7%) increased the odds of DMARD use (P < 0.0001). Use of certain classes of medication, such as nonsteroidal anti-inflammatory drugs (12.3%), opioids (19.5%), antidepressants (20.0%), muscle relaxants (12.5%), and anticonvulsants (15.5%), were associated with lower use of DMARDs (P < 0.0001). CONCLUSIONS We found significant differences in demographic and clinical characteristics between patients with and without DMARD use, which can potentially inform treatment decisions regarding DMARD use as deemed necessary by the provider. Future research should investigate the reasons for lack of treatment. DISCLOSURES This study was supported by funding from Eli Lilly to Humana as a collaborative research project involving employees of both companies. Boytsov, Saverno, Zhang, and Gaich are employees of Eli Lilly. Nair, Bhattacharya, Abbott, and Dixon are employees of Humana, which received funding from Eli Lilly to complete this research.
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Affiliation(s)
| | | | | | | | | | | | | | - Radhika Nair
- Humana Healthcare Research, Louisville, Kentucky
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Ahluwalia V, Rampakakis E, Movahedi M, Cesta A, Li X, Sampalis JS, Bombardier C. Predictors of patient decision to discontinue anti-rheumatic medication in patients with rheumatoid arthritis: results from the Ontario best practices research initiative. Clin Rheumatol 2017; 36:2421-2430. [PMID: 28879413 DOI: 10.1007/s10067-017-3805-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/16/2017] [Accepted: 08/25/2017] [Indexed: 01/28/2023]
Abstract
Despite the availability of treatment guidelines and effective treatments, real-world effectiveness remains suboptimal partly due to poor patient medication adherence. We evaluated a comprehensive set of sociodemographic, health insurance, and disease-related factors for association with patient decision to discontinue anti-rheumatic medications (ARMs) in a large observational RA cohort in Ontario, Canada. Patients from the Ontario Best Practices Research Initiative registry were included. The following predictors of ARM discontinuation were evaluated with cox-regression: patient age, gender, education, income, smoking, health insurance type/coverage, RA duration, erosion presence, RF positivity, DAS28-ESR, physician global, HAQ-DI, comorbidity number, ARM types, and physician characteristics (gender, academic position, urban vs. rural, distance from patient's residence). Patients (1762) were included with a mean (SD) age of 57.4 years (13.0). Approximately 80% were female, 29% had early (≤ 1 year) RA, and 70% were RF-positive. Mean (SD) baseline DAS28-ESR and HAQ-DI were 4.5 (1.5) and 1.2 (0.76), respectively. In multivariate analysis, married status (HR [95%CI] 0.73 [0.56-0.96]), RF positivity (0.73 [0.56-0.96]), and higher comorbidity number (0.92 [0.85-0.99]) were significant predictors of ARMs continuation while higher physician global (1.10 [1.04-1.15]), NSAID use (1.75 [1.29-2.38]), and number of ARMs (1.23 [1.07-1.40]) were associated with ARMs discontinuation. In a subset analysis assessing conventional or biologic DMARD discontinuation, higher HAQ-DI and biologic use over time were associated with lower hazard for discontinuation. Several sociodemographic, disease, and treatment parameters were identified as independent predictors of patient discontinuation of ARMs. These results should be considered when developing patient adherence support programs and in the choice of treatment regimens.
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Affiliation(s)
- Vandana Ahluwalia
- William Osler Health System, 314-40 Finchgate Blvd, Brampton, ON, L6T 3J1, Canada.
| | | | - Mohammad Movahedi
- JSS Medical Research, St-Laurent, QC, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Angela Cesta
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Xiuying Li
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - John S Sampalis
- JSS Medical Research, St-Laurent, QC, Canada.,McGill University, Montreal, QC, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada
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7
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Goh H, Kwan YH, Seah Y, Low LL, Fong W, Thumboo J. A systematic review of the barriers affecting medication adherence in patients with rheumatic diseases. Rheumatol Int 2017; 37:1619-1628. [PMID: 28681249 DOI: 10.1007/s00296-017-3763-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/28/2017] [Indexed: 12/22/2022]
Abstract
Medication adherence is a crucial part in the management of rheumatic diseases, especially with many such patients requiring long-term medications. In this paper, we aim to systematically review the literature for the factors associated with medication adherence in the rheumatic patient population. We carried out a systematic literature search using PubMed®, PsychInfo® and Embase ® with relevant keywords and employed the PRISMA® criteria. We included English peer-reviewed articles that studied the factors affecting medication adherence in patients with rheumatic diseases, which were assessed by two independent reviewers. Hand searches were conducted and relevant factors were extracted and classified using the World Health Organization (WHO)'s five dimensions of medication adherence. A simple diagram was drawn to summarise the factors extracted. 1977 articles were identified and reviewed and 90 articles were found to be relevant. A total of 17 factors and 38 sub-factors were identified and categorized based on the WHO's five dimensions of medication adherence. A hand model for medication adherence was developed to succinctly summarise these dimension to remind clinicians the importance of medication adherence in daily practice. We conducted a systematic review on the various factors including patient, therapy, condition, health system and socioeconomic-related factors that affected medication adherence in rheumatic patients. We found 17 factors and 38 sub-factors that affected medication adherence in this population. This systematic review can facilitate future focused research in unexplored dimensions.
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Affiliation(s)
- Hendra Goh
- Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
- Department of Pharmacy, Khoo Teck Puat Hospital, Singapore, Singapore.
- Singapore Heart Foundation, Singapore, Singapore.
| | - Yi Seah
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Julian Thumboo
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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8
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Michetti P, Weinman J, Mrowietz U, Smolen J, Peyrin-Biroulet L, Louis E, Schremmer D, Tundia N, Nurwakagari P, Selenko-Gebauer N. Impact of Treatment-Related Beliefs on Medication Adherence in Immune-Mediated Inflammatory Diseases: Results of the Global ALIGN Study. Adv Ther 2016. [PMID: 27854054 DOI: 10.1007/s12325-016-0441-3 10.1007/s12325-017-0602-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Medication adherence is critical in chronic immune-mediated inflammatory diseases (IMIDs) and could be affected by patients' treatment-related beliefs. The objective of this study was to determine beliefs about systemic medications in patients with IMIDs and to explore the association of those beliefs and other factors with adherence. METHODS This was a multi-country, cross-sectional, self-administered survey study. Included were adults diagnosed with one of six IMIDs receiving conventional systemic medications and/or tumor necrosis factor inhibitors (TNFi). Patients' necessity beliefs/concerns towards and adherence to treatments were assessed by the Beliefs about Medicines Questionnaire and four-item Morisky Medication Adherence Scale. Correlation of patients' beliefs about treatment and other factors with adherence were evaluated by multivariable regression analyses. RESULTS Among studied patients (N = 7197), 32.0% received TNFi monotherapy, 27.7% received TNFi-conventional combination therapy, and 40.3% received conventional medications. Across IMIDs, high adherence to systemic treatment was more prevalent in TNFi groups (61.3-80.7%) versus corresponding conventional treatment groups (28.4-64.7%). In at least four IMIDs, greater perception of the illness continuing forever (P < 0.001), of the treatment helping (P < 0.001), and more concerns about the illness (P < 0.01), but not clinical parameters, were associated with higher treatment necessity beliefs. Higher treatment necessity beliefs, older age, Caucasian race, and TNFi therapy were associated with high medication adherence in at least four IMIDs. CONCLUSIONS Treatment necessity beliefs were higher than concerns about current medication in patients with IMID. Illness perceptions had a greater impact on treatment necessity beliefs than clinical parameters. Older age, greater treatment necessity beliefs, and TNFi therapy were associated with high self-reported medication adherence in at least four IMIDs. TRIAL REGISTRATION ACTRN12612000977875. FUNDING AbbVie.
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Affiliation(s)
- Pierre Michetti
- Crohn and Colitis Centre, Gastro-entérologie La Source-Beaulieu and Division of Gastroenterology, Centre Hospitalier Universitaire Vaudois, 1004, Lausanne, Switzerland.
| | - John Weinman
- Institute of Pharmaceutical Sciences, King's College London, London, UK
| | - Ulrich Mrowietz
- Psoriasis-Center at the Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Josef Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.,2nd Department of Medicine, Center for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria
| | - Laurent Peyrin-Biroulet
- Inserm U954 and Department of Gastroenterology, Université de Lorraine, Vandoeuvre-les-Nancy, France
| | | | | | | | - Pascal Nurwakagari
- Medical Department, AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
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9
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Michetti P, Weinman J, Mrowietz U, Smolen J, Peyrin-Biroulet L, Louis E, Schremmer D, Tundia N, Nurwakagari P, Selenko-Gebauer N. Impact of Treatment-Related Beliefs on Medication Adherence in Immune-Mediated Inflammatory Diseases: Results of the Global ALIGN Study. Adv Ther 2016; 34:91-108. [PMID: 27854054 PMCID: PMC5216107 DOI: 10.1007/s12325-016-0441-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Indexed: 11/30/2022]
Abstract
Introduction Medication adherence is critical in chronic immune-mediated inflammatory diseases (IMIDs) and could be affected by patients’ treatment-related beliefs. The objective of this study was to determine beliefs about systemic medications in patients with IMIDs and to explore the association of those beliefs and other factors with adherence. Methods This was a multi-country, cross-sectional, self-administered survey study. Included were adults diagnosed with one of six IMIDs receiving conventional systemic medications and/or tumor necrosis factor inhibitors (TNFi). Patients’ necessity beliefs/concerns towards and adherence to treatments were assessed by the Beliefs about Medicines Questionnaire and four-item Morisky Medication Adherence Scale. Correlation of patients’ beliefs about treatment and other factors with adherence were evaluated by multivariable regression analyses. Results Among studied patients (N = 7197), 32.0% received TNFi monotherapy, 27.7% received TNFi–conventional combination therapy, and 40.3% received conventional medications. Across IMIDs, high adherence to systemic treatment was more prevalent in TNFi groups (61.3–80.7%) versus corresponding conventional treatment groups (28.4–64.7%). In at least four IMIDs, greater perception of the illness continuing forever (P < 0.001), of the treatment helping (P < 0.001), and more concerns about the illness (P < 0.01), but not clinical parameters, were associated with higher treatment necessity beliefs. Higher treatment necessity beliefs, older age, Caucasian race, and TNFi therapy were associated with high medication adherence in at least four IMIDs. Conclusions Treatment necessity beliefs were higher than concerns about current medication in patients with IMID. Illness perceptions had a greater impact on treatment necessity beliefs than clinical parameters. Older age, greater treatment necessity beliefs, and TNFi therapy were associated with high self-reported medication adherence in at least four IMIDs. Trial registration ACTRN12612000977875. Funding AbbVie. Electronic supplementary material The online version of this article (doi:10.1007/s12325-016-0441-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pierre Michetti
- Crohn and Colitis Centre, Gastro-entérologie La Source-Beaulieu and Division of Gastroenterology, Centre Hospitalier Universitaire Vaudois, 1004, Lausanne, Switzerland.
| | - John Weinman
- Institute of Pharmaceutical Sciences, King's College London, London, UK
| | - Ulrich Mrowietz
- Psoriasis-Center at the Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Josef Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
- 2nd Department of Medicine, Center for Rheumatic Diseases, Hietzing Hospital, Vienna, Austria
| | - Laurent Peyrin-Biroulet
- Inserm U954 and Department of Gastroenterology, Université de Lorraine, Vandoeuvre-les-Nancy, France
| | | | | | | | - Pascal Nurwakagari
- Medical Department, AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
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10
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Hendrikx J, Kievit W, Fransen J, van Riel PLCM. The influence of patient perceptions of disease on medication intensification in daily practice. Rheumatology (Oxford) 2016; 55:1938-1945. [PMID: 27009827 DOI: 10.1093/rheumatology/kew041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 02/11/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The objectives of this study were twofold: to assess if there are independent effects of variables representing patients' perceptions of disease on intensification of drug therapy in patients with RA seen in daily practice; and to test the hypothesis that effects of patients' perceptions of disease are mediated through patient self-reported willingness to alter therapy. METHODS Before being seen by a physician, consecutive patients with RA, attending the Radboudumc outpatient rheumatology clinic, were asked to fill out a short questionnaire regarding the following four items: perceived health change, satisfaction with current health, willingness to change therapy and expected health change until the next visit. Independent associations between these measures, registered clinical measures and synthetic DMARD/biologic DMARD (including CSs) intensification were studied with logistic regression. Mediation analysis was performed focusing on the strongest predictor and self-reported willingness as a mediator. RESULTS Out of 453 patients with RA, 65% female, 67% RF positive, medication was intensified for 82 patients (18%). All patient perception measures exhibited significant associations, independent of clinical measures, of which patient satisfaction with current health state was the strongest [odds ratio (OR) 0.21, 95% CI: 0.10, 0.44]. Significant mediation of the effect of patient satisfaction through willingness to alter therapy on actual registered medication intensification was found. CONCLUSION Treat to Target interventions should address patients' perceptions of their disease, and the related health goals patients aim to achieve, in addition to the attained level of disease activity.
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Affiliation(s)
- Jos Hendrikx
- Department of Rheumatology .,Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center
| | - Wietske Kievit
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Piet L C M van Riel
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center
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11
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de Thurah A, Nørgaard M, Stengaard-Pedersen K. Methotrexate utilization in Rheumatoid arthritis. A register-based cohort-study of treatment re-starts after gabs of at least 90 days. SPRINGERPLUS 2015; 4:227. [PMID: 26110100 PMCID: PMC4474972 DOI: 10.1186/s40064-015-0975-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/10/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine restart of MTX treatment among patients with rheumatoid arthritis (RA) who discontinues treatment, and investigate predictors of restart. METHODS A cohort study was conducted based on data from medical databases. MTX drug discontinuation was defined as a gap ≥ 90 days from the expiration of one MTX prescription to the redemption of a new one. Kaplan Meier estimates were used to compute the cumulative probability of restarting MTX treatment and Cox proportional hazard to estimate the hazard of return to treatment. A case-crossover analysis compared the frequency of events that could potentially have a transient effect on MTX restart. RESULTS Among 788 patients, who started MTX, 299 patients experienced a gap ≥ 90 days. Within 1.4 years 50 % of these patients returned to treatment, and a total of 66 % restarted treatment during follow-up. Concurrent treatment with corticosteroid and disease-modifying antirheumatic drugs (DMARDs) tended to be negatively associated with MTX restart (OR: 0.7(95 % CI: 0.5-1.2) and (OR: 0.7 (95 % CI: 0.4-1.0)). Older patients were less inclined to restart treatment than middle-aged patients (Adjustet HR 0.7 (0.4-1.2)). Patients with a CRP > 300 nmol/L less often restarted MTX than patients with a CRP < 75 nmol/L (adjHR: 0.6 (95 % CI 0.3-1.2)), and men were more inclined to MTX restart than women (adjHR 1.30 (95 % CI 0.9-2.0)). CONCLUSION It is important to support patients in remaining continuous users of MTX. A large proportion of RA patients who discontinued MTX later restarted treatment, but especially patients with high disease activity, old age or co-morbidity were less inclined to restart treatment.
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Affiliation(s)
- Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark ; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Institute of Clinical Medicine, University Hospital, Aarhus, Denmark
| | - Kristian Stengaard-Pedersen
- Department of Rheumatology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark ; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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