1
|
Wabe N, Meulenbroeks I, Firempong DC, Raban MZ, Nguyen AD, Close JT, Lord SR, Westbrook JI. Vitamin D supplementation and falls in residential aged care: A longitudinal multisite cohort study. Bone Rep 2024; 22:101791. [PMID: 39139591 PMCID: PMC11321375 DOI: 10.1016/j.bonr.2024.101791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 06/24/2024] [Accepted: 07/15/2024] [Indexed: 08/15/2024] Open
Abstract
Background Vitamin D is vital for musculoskeletal health, and supplementation may lower risk of falls. Past research in residential aged care (RAC) settings on the effects of vitamin D on falls have reported inconclusive findings, partly due to study design limitations. We utilised a longitudinal study design to assess the association between the use of vitamin D and falls over 36 months in RAC. Method A longitudinal cohort study was conducted using routinely collected electronic data spanning 9 years from 27 RAC facilities in Sydney, New South Wales, Australia. The study included 4520 permanent residents aged 65 years or older who were admitted for the first time from 1 July 2014 and stayed for a minimum of one month. We identified daily vitamin D usage over 36 months, and measured adherence using the Proportion of Days Covered (PDC) metric. A PDC value of ≥80 % signifies optimal adherence. Primary outcomes were the number of all falls and injurious falls. A rolling time-varying predictor-outcome approach and Generalized Estimating Equations (GEE) were applied to determine the longitudinal link between vitamin D supplement use and subsequent risk of falls. Results Over two-thirds of residents (67.8 %; n = 3063) received vitamin D supplements during their stay, with a median PDC of 74.8 % among users, and 44.6 % (n = 1365) achieving optimal adherence. Increasing age, osteoporosis or fracture history, and dementia were associated with a greater likelihood of achieving optimal adherence. Crude fall incident rates were 8.05 and 2.92 incidents per 1000 resident days for all falls and injurious falls respectively. After accounting for relevant demographic and clinical factors, no significant links were observed between vitamin D supplement usage and fall outcomes: all falls (Incident Rate Ratio [IRR] 1.01; 95 % CI 1.00-1.02; P = 0.237) and injurious falls (IRR 1.01; 95 % CI 1.00-1.02; P = 0.091). Conclusion Vitamin D supplementation was not associated with a reduced risk of falls, suggesting it is not an effective intervention for preventing falls in RAC. While clinicians should ensure adequate vitamin D intake for residents' nutritional and bone health, it should not be a standalone falls prevention intervention in RAC populations.
Collapse
Affiliation(s)
- Nasir Wabe
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Isabelle Meulenbroeks
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Desiree C. Firempong
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Magdalena Z. Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Amy D. Nguyen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
- St Vincent's Clinical School, University of New South Wales Medicine, UNSW Sydney, Sydney, Australia
| | - Jacqueline T. Close
- Neuroscience Research Australia, UNSW Sydney, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Stephen R. Lord
- Neuroscience Research Australia, UNSW Sydney, Sydney, Australia
- School of Population Health, UNSW, Sydney, Australia
| | - Johanna I. Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
| |
Collapse
|
2
|
Wabe N, Huang G, Silva SM, Nguyen AD, Seaman K, Raban MZ, Gates P, Day R, Close JCT, Lord SR, Westbrook JI. A Longitudinal Study of the Use and Effects of Fall-Risk-Increasing Drugs in Residential Aged Care. J Am Med Dir Assoc 2024; 25:105074. [PMID: 38857685 DOI: 10.1016/j.jamda.2024.105074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/04/2024] [Accepted: 05/06/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVES Fall-risk-increasing drugs (FRIDs)-psychotropics and cardiovascular disease (CVD) drugs-may elevate the risk of falling, with strong evidence observed in psychotropic FRIDs, whereas findings from cardiovascular disease (CVD) FRIDs remain inconclusive. Existing studies on FRIDs and falls are often hampered by methodologic limitations. Leveraging longitudinal observational data, we aimed to determine the long-term patterns of FRID use and their association with falls in residential aged care (RAC) homes. DESIGN A retrospective longitudinal cohort study. SETTING AND PARTICIPANTS A total of 4207 permanent residents newly admitted to 27 RAC homes in Sydney, Australia. METHOD The outcomes were incidence of all and injurious falls. We measured exposure to each FRID over 60 months using the Proportion of Days Covered (PDC) metric. We used group-based multitrajectory modeling to determine concurrent usage patterns of psychotropics and CVD FRIDs and applied negative binomial regression to assess their associations with the outcomes. RESULTS A total of 83.6% (n = 3516) and 77.3% (n = 3254) residents used psychotropic and CVD FRIDs, respectively. The PDC values ranged from 67.3% (opioids) to 86.9% (antidepressants) for specific psychotropics and 79.0% (α-adrenoceptor antagonists) to 89.6% (β blockers) for CVD FRIDs. We identified 4 groups: group 1, low psychotropics-low CVDs use (16.7%, n = 701); group 2, low psychotropics-high CVDs (25.0%, n = 1054); group 3, high psychotropics-high CVDs (41.0%, n = 1723); and group 4, high psychotropics-low CVDs (17.3%, n = 729). Group 4 had a significantly higher rate of falls than the other groups for both outcomes, including relative to group 3, in which exposure to both FRID classes was high. CONCLUSIONS AND IMPLICATIONS Our findings reveal concerningly high FRID use in RAC homes and highlight a critical difference in the impact of the 2 major FRID classes on falls. Psychotropics were strongly associated with falls, whereas the studied CVD FRIDs did not elevate risk of falling.
Collapse
Affiliation(s)
- Nasir Wabe
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia.
| | - Guogui Huang
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Sandun M Silva
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Amy D Nguyen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia; St Vincent's Clinical School, University of New South Wales Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Karla Seaman
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| | - Peter Gates
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Ric Day
- St Vincent's Clinical School, University of New South Wales Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jacqueline C T Close
- Neuroscience Research Australia, UNSW Sydney, Sydney, New South Wales, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, UNSW Sydney, Sydney, New South Wales, Australia; School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia
| |
Collapse
|
3
|
Harris JT, Yang Y, Bentley JP, Chen Y, Ramachandran S. Estimation of optimal adherence threshold for tumor necrosis factor inhibitors in rheumatoid arthritis. Clin Rheumatol 2024; 43:2435-2444. [PMID: 38853227 PMCID: PMC11269320 DOI: 10.1007/s10067-024-06971-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/27/2024] [Accepted: 04/14/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Optimal adherence thresholds can vary across medications and disease states. The objective of the study was to determine the optimal threshold of the proportion of days covered (PDC) for tumor necrosis factor (TNF) inhibitors in patients with rheumatoid arthritis (RA). METHODS Patients with RA initiating self-administered TNF inhibitors were identified using 2012-18 Medicare fee-for-service claims. Time-varying PDC was calculated every day for the preceding 90 days during follow-up. Oral and injected glucocorticoid use, hospitalizations, emergency room (ER) visits, serious infections, and a composite of these were measured as outcomes. Time to first occurrence of each outcome as a function of time-varying PDC for TNF inhibitors was evaluated using Cox regression. Incident/dynamic time-dependent receiver operating characteristic curves and Youden's J index were used to obtain the optimal PDC threshold for outcomes at 365 days. RESULTS Of the 1190 patients who met the study inclusion criteria, almost 75% (865 patients) experienced at least one of the outcomes. Increasing PDC by 10% was significantly associated with decreased risks of the composite outcome (HR 0.98, 95% CI 0.96-1.00), oral glucocorticoid use (HR 0.93, 95% CI 0.91-0.96), and hospitalization (HR 0.96, 95% CI 0.94-0.99) but an increased risk of ER visits (HR 1.04, 95% 1.01-1.07). Optimal PDC thresholds for the composite outcome, oral glucocorticoid use, and hospitalization were 0.64, 0.59, and 0.56, respectively. CONCLUSIONS Increased PDC was associated with a decreased risk of adverse outcomes, except ER visits. The optimal PDC for TNF inhibitors in Medicare patients with RA based on clinical outcomes was about 60%. Key Points • The optimal proportion of days covered threshold for tumor necrosis factor inhibitors at 365 days based on clinical outcomes was found to be about 60%, which is lower than the traditional 80% used to define adherence. • Increased adherence was associated with decreased risks of oral glucocorticoid use, hospitalization, and the composite outcome. However, it was also associated with an increased risk of emergency room visits. • The mean time-varying 90-day proportion of days covered decreased throughout the study starting 92% at day 1 of follow-up to 62% at day 365.
Collapse
Affiliation(s)
| | - Yi Yang
- University of Mississippi, P.O. Box 1848, University, MS, 38677, USA
| | - John P Bentley
- University of Mississippi, P.O. Box 1848, University, MS, 38677, USA
| | - Yixin Chen
- University of Mississippi, P.O. Box 1848, University, MS, 38677, USA
| | | |
Collapse
|
4
|
Michaud K, Pedro S, Tousset E, Schumacher R, Agarwal E, Vrijens B. Treatment Adherence and Adherence Patterns of Tofacitinib and Self-Injectable TNFi Use in People with Rheumatoid Arthritis. ACR Open Rheumatol 2024; 6:72-80. [PMID: 38041515 PMCID: PMC10867288 DOI: 10.1002/acr2.11622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 09/15/2023] [Accepted: 09/27/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVE To assess tofacitinib and self-injectable tumor necrosis factor inhibitor (TNFi) adherence using the Medication Event Monitoring System (MEMS) and characterize association with adherence in patients with rheumatoid arthritis (RA). METHODS Eligible patients were enrolled from the Forward Databank within 6 months of initiating tofacitinib or injectable TNFi or from participating clinics where these were first prescribed. MEMS caps and patient diaries were used to compile dosing over 9 months. Demographics and disease characteristics were collected every 6 months, and the Beliefs about Medicines Questionnaire only at baseline. Adherence along with its components, initiation, implementation, and persistence, were calculated. RESULTS Of the 112 consented to participate, 82 (73%) remained in the final analysis with recruitment from clinics 47 (57%) and Forward 35 (43%). Sixty-two (76%) initiated tofacitinib with 87% taking it quaque die and twenty (24%) TNFi. At 9 months, 77% of tofacitinib were persistent versus 70% for TNFi (P = 0.65), and implementation was similar (0.84 vs. 0.82; P = 0.57). In multivariable models, increased baseline patient global assessment was consistently associated with discontinuation (hazard ratio 1.31 [1.07-1.61]). There was increased adherence to methotrexate (MTX) when taking tofacitinib that led to higher combined adherence for tofacitinib than TNFi (0.81 vs. 0.69; P = 0.03), but no significant differences remained in multivariable models. In sensitivity analysis, consistent morning intake for tofacitinib and evening intake for MTX was associated with improved adherence. CONCLUSION We found no statistical differences in adherence between patients with RA initiating tofacitinib and self-injectable TNFi, although 15% to 30% were nonadherent. Concomitant MTX, patient global assessment, and a consistent time of day intake were associated with adherence.
Collapse
Affiliation(s)
- Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and Forward DatabankWichitaKS
| | | | | | | | | | | |
Collapse
|
5
|
Zanetti A, Zambon A, Scirè CA, Bugatti S, Montecucco C, Sakellariou G. Impact of csDMARDs adherence on clinical remission in patients with new-onset inflammatory arthritis: a prospective cohort study from the ELECTRA database. Ther Adv Musculoskelet Dis 2023; 15:1759720X231194179. [PMID: 37807981 PMCID: PMC10552453 DOI: 10.1177/1759720x231194179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/26/2023] [Indexed: 10/10/2023] Open
Abstract
Background Major improvements in the management of rheumatoid arthritis (RA) have made clinical remission an achievable and desirable goal but, despite the relevance gained by a profound disease suppression, many patients with RA still miss clinical remission due to several factors influencing disease activity, including treatment adherence. Objective To evaluate the effect of adherence to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) on the achievement of clinical remission in a cohort of patients with new-onset inflammatory arthritis. Study design A prospective cohort study was conducted using the ELECTRA database, which consists of clinical data from patients followed at the IRCCS Policlinico San Matteo Foundation (Pavia, Italy), linked to regional administrative healthcare databases. Methods We enrolled patients with new-onset active disease between January 2006 and December 2013 and followed them until their first clinical remission or end of follow-up (December 2015). To assess the association of csDMARD adherence with clinical remission, we estimated the csDMARD proportion of days covered (PDC) during follow-up. PDC was added to the main clinical adjustment covariates as a time-dependent variable in a proportional hazard Cox regression model. Results The cohort included 324 patients with a mean (SD) age of 58 (13.9) and predominantly female (74.5%). A total of 219 patients (67.6%) achieved clinical remission during follow-up and 85 (26.2%) in the first 6 months (early clinical remission). Cox regression models showed that a 10% increment of PDC increased the probability of achieving clinical remission by 10% (p < 0.001) and the probability of early clinical remission by 21% (p = 0.03). Conclusion Patients at disease onset with higher adherence to csDMARDs were more likely to achieve clinical remission and early clinical remission. Our study highlighted the importance of close monitoring of patients to increase their likelihood of following therapeutic indications and achieving favorable disease outcomes, such as lower disability.
Collapse
Affiliation(s)
- Anna Zanetti
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Antonella Zambon
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Carlo A. Scirè
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Serena Bugatti
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Carlomaurizio Montecucco
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Garifallia Sakellariou
- Istituti Clinici Scientifici Maugeri IRCCS, via Salvatore Maugeri 10, 27100 Pavia, Italy
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
| |
Collapse
|
6
|
Neycheva S, Naseva E, Batalov Z, Karalilova R, Batalov A. Adherence to biological therapies in patients with rheumatoid arthritis: a retrospective cohort study. Rheumatol Int 2023; 43:1287-1296. [PMID: 37074381 DOI: 10.1007/s00296-023-05327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/08/2023] [Indexed: 04/20/2023]
Abstract
The advent of biologic disease-modifying antirheumatic drugs has dramatically changed the comprehensions of treatment and long-term prognosis in patients with rheumatoid arthritis. The potent therapeutic results can only be achieved if the patients adhere to prescribed medications. The objective of this study was to estimate the impact of age, gender, duration of the disease, concomitant Methotrexate therapy, prior exposure to biologic agents, disease activity, functional capacity, and health-related quality of life on adherence to biologic treatment among Bulgarian population with rheumatoid arthritis. This was a retrospective observational cohort study that included 179 patients. At the baseline visit and subsequent follow-up assessments at 6, 12, 24 and 36 months, patients were interviewed by a physician and underwent physical examinations. We monitored the changes in disease activity, functional capacity and health-related quality of life on each time point. Univariate and multivariate binary logistic regression was used to determine the prognostic value of possible predictors of treatment adherence. Our findings showed that only DAS28 score [odd ratio (OR) = 1.174; 95% CI 1.74-2.362] and HAQ score (OR 2.803; 95% CI 1.428-5.503) remained significant for the treatment adherence throughout the study period. The adherence to the biologic disease-modifying anti-rheumatic drugs among Bulgarian patients with rheumatoid arthritis is suboptimal. A multifaceted and comprehensive knowledge of the influencing factors can be useful for the development of different strategies that can improve treatment adherence.
Collapse
Affiliation(s)
- Stefka Neycheva
- Department of Rheumatology, Military Medical Academy, MHAT-Sofia, 3 Sveti Georgi Sofiyski Str., 1606, Sofia, Bulgaria.
| | - Emilia Naseva
- Faculty of Public Health "Prof. Tsekomir Vodenicharov, MD, DSc", Medical University of Sofia, 8 Byalo More Str., 1527, Sofia, Bulgaria
| | - Zguro Batalov
- Clinic of Rheumatology, UMHAT "Kaspela", Medical University of Plovdiv, 64 Sofia Str., 4000, Plovdiv, Bulgaria
| | - Rositsa Karalilova
- Clinic of Rheumatology, UMHAT "Kaspela", Medical University of Plovdiv, 64 Sofia Str., 4000, Plovdiv, Bulgaria
| | - Anastas Batalov
- Clinic of Rheumatology, UMHAT "Kaspela", Medical University of Plovdiv, 64 Sofia Str., 4000, Plovdiv, Bulgaria
| |
Collapse
|
7
|
Pouls BP, Bekker CL, van Dulmen S, Vriezekolk JE, van den Bemt BJ. A Serious Puzzle Game to Enhance Adherence to Antirheumatic Drugs in Patients With Rheumatoid Arthritis: Systematic Development Using Intervention Mapping. JMIR Serious Games 2022; 10:e31570. [PMID: 35179510 PMCID: PMC8900908 DOI: 10.2196/31570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/08/2021] [Accepted: 11/06/2021] [Indexed: 12/14/2022] Open
Abstract
Background Patients’ implicit attitudes toward medication need and concerns may influence their adherence. Targeting these implicit attitudes by combining game-entertainment with medication-related triggers might improve medication adherence in patients with rheumatoid arthritis (RA). Objective The aim of this study was to describe the systematic development of a serious game to enhance adherence to antirheumatic drugs by using intervention mapping. Methods A serious game was developed using the intervention mapping framework guided by a multidisciplinary expert group, which proceeded along 6 steps: (1) exploring the problem by assessing the relationship between medication adherence and implicit attitudes, (2) defining change objectives, (3) selecting evidence-based behavior change techniques that focused on adjusting implicit attitudes, (4) designing the intervention, (5) guaranteeing implementation by focusing on intrinsic motivation, and (6) planning a scientific evaluation. Results Based on the problem assessment and guided by the Dual-Attitude Model, implicit negative and illness-related attitudes of patients with RA were defined as the main target for the intervention. Consequently, the change objective was “after the intervention, participants have a more positive attitude toward antirheumatic drugs.” Attention bias modification, evaluative conditioning, and goal priming were the techniques chosen to implicitly target medication needs. These techniques were redesigned into medication-related triggers and built in the serious puzzle game. Thirty-seven patients with RA tested the game at several stages. Intrinsic motivation was led by the self-determination theory and addressed the 3 needs, that is, competence, autonomy, and relatedness. The intervention will be evaluated in a randomized clinical trial that assesses the effect of playing the serious game on antirheumatic drug adherence. Conclusions We systematically developed a serious game app to enhance adherence to antirheumatic drugs among patients with RA by using the intervention mapping framework. This paper could serve as a guideline for other health care providers when developing similar interventions.
Collapse
Affiliation(s)
- Bart Ph Pouls
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Sandra van Dulmen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands.,Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Johanna E Vriezekolk
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands
| | - Bart Jf van den Bemt
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| |
Collapse
|
8
|
van Heuckelum M, van den Ende CHM, van Dulmen S, van den Bemt BJF. Electronic Monitoring Feedback for Improving Medication Adherence and Clinical Outcomes in Early Rheumatoid Arthritis: A Randomized Clinical Trial. Patient Prefer Adherence 2021; 15:1107-1119. [PMID: 34079231 PMCID: PMC8164714 DOI: 10.2147/ppa.s297170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/19/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Non-adherence to medication (range 30-107%) is a major issue in patients with rheumatoid arthritis (RA). Previous research has shown that electronic monitoring feedback (EMF) might be an effective strategy to improve medication adherence in chronic conditions. Therefore, this study investigated the effectiveness of electronic monitoring feedback in patients with early RA to improve medication adherence and clinical outcomes compared to usual care. METHODS An open-label randomized clinical trial was performed to compare EMF with standard care during a 12-month follow-up period on two sites of the Sint Maartenskliniek (Nijmegen and Boxmeer) in the Netherlands. Patients were eligible if they: (1) had a (working) diagnosis of early RA, (2) were currently using methotrexate, (3) were aged ≥18 years, and (4) had a life expectancy of ≥12 months. Primary outcome was the difference in proportion of non-adherent patients measured with the Compliance Questionnaire on Rheumatology after 12 months. Secondary outcomes were beliefs about medicines, medication adherence measured with the MMAS-8®, patients' health status, prescription of biologic DMARDs, and disease activity after 12 months. RESULTS Of the 367 initially-invited patients, 93 patients with early RA agreed to participate in this study. No significant difference was found in the proportion of non-adherent patients between the intervention arm and the usual care arm after 12 months follow-up (60.0% and 61.3%, p=0.93, respectively). Patients in the intervention arm tended to discontinue methotrexate earlier than patients in the usual care arm (median time in weeks: 15.7 (9.1-33.6) and 21.9 (19-28.4), respectively, p=0.31), whereas patients in the usual care arm tended to initiate biologic DMARDs earlier than those in the intervention arm (median time in weeks: 11.9 (5.7-22) and 17 (9.9-40.9), respectively, p=0.55). CONCLUSION This study illustrates the challenge of targeting non-adherence with EMF in patients with early RA and shares important lessons learned about designing adherence intervention trials with respect to study attrition, accounting for drug survival, intervention fidelity, intervention uptake, and technical aspects.
Collapse
Affiliation(s)
- Milou van Heuckelum
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Cornelia H M van den Ende
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sandra van Dulmen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| |
Collapse
|
9
|
Hayes K, Panaccio MP, Goel N, Fahim M. Patient Characteristics and Indicators of Treatment Initiation with Repository Corticotropin Injection in Patients with Rheumatoid Arthritis: A Claims Database Analysis. Rheumatol Ther 2021; 8:327-346. [PMID: 33400194 PMCID: PMC7991008 DOI: 10.1007/s40744-020-00272-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/11/2020] [Indexed: 12/04/2022] Open
Abstract
Repository corticotropin injection (RCI) is indicated as adjunctive, short-term therapy in selected patients with RA. To characterize RCI users and identify predictors of RCI initiation in RA, we compared preindex characteristics, treatment patterns, comorbidities, healthcare resource utilization (HCRU), and costs for patients who had initiated RCI treatment (RCI cohort) versus patients with no RCI claims and ≥ 1 targeted synthetic or biologic disease-modifying antirheumatic drugs (ts/bDMARD) claim (non-RCI ts/bDMARD cohort). We analyzed pharmacy and medical claims data from a large commercial and Medicare supplemental administrative database. Inclusion criteria were age ≥ 18 years, ≥ 1 inpatient or ≥ 2 outpatient claims with RA diagnosis (January 1, 2007–December 31, 2018), and 12-month continuous medical and pharmacy coverage preindex. Results from baseline cohort comparisons informed multiple logistic regression analysis. Compared with the non-RCI ts/bDMARD cohort (n = 162,065), the RCI cohort (n = 350) had a greater proportion of patients with higher Charlson comorbidity index (CCI) scores; higher mean claims-based index of RA severity and CCI scores; greater frequency of almost all comorbidities; higher use of nontraditional DMARDs, glucocorticoids, and opioids; higher all-cause HCRU; and higher medical and total costs. By multivariable analysis, the most significant predictors of RCI initiation were intermittent glucocorticoid use at any dose (odds ratio [OR] 1.67), extended-use glucocorticoids at medium (OR 2.03) and high doses (OR 2.99), nontraditional DMARD use (OR 2.09), anemia (OR 1.39), and renal disease (OR 2.45). Before RCI initiation, patients had more severe RA, higher comorbidity burden, greater use of glucocorticoids and opioids, and higher HCRU compared with non-RCI initiators. The most significant predictors for starting RCI in patients with RA were intermittent use of glucocorticoids at any dose, extended-use high-dose glucocorticoids, use of nontraditional DMARDs, and comorbid anemia and renal disease.
Collapse
Affiliation(s)
- Kyle Hayes
- Mallinckrodt Pharmaceuticals, Hazelwood, MO, USA.
| | | | - Niti Goel
- Caduceus Biomedical Consulting, LLC, Durham, NC, USA
| | | |
Collapse
|
10
|
Gallotti FC, Serafini MR, Thomazzi SM. Scenario of the Treatment of Arthritis with Natural Products. ACTA ACUST UNITED AC 2021; 14:95-105. [DOI: 10.2174/1872213x14666200228103001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/19/2020] [Accepted: 02/23/2020] [Indexed: 11/22/2022]
Abstract
Background:
Conventional treatments of arthritis use toxic and poorly tolerated drugs.
Therefore, natural products are an alternative because they are important sources of bioactive substances
with therapeutic potential.
Objective:
To perform synthesis of patent applications associated with the use of natural products
in the technological development of the invention for use in treating arthritis.
Methods:
The search for patents was conducted using the following databases of World Intellectual
Property Organization (WIPO), European Patent Office (EPO, Espacenet), United States Patents
and Trademark Office (USPTO) and National Institute of Intellectual Property (INPI) using as keywords
- arthritis, treatment and the International Patent Classification (IPC) A61K36 / 00.
Results:
A total of 617 patents related to the subject were registered in the period available in patents
databases during the study period from the years 2005 to 2017, of which 44 were analyzed
based on the established inclusion criteria. The most important countries for protecting these inventions
were China, followed by the United States of America, the Republic of Korea and Japan. As
for the typology of depositors, that were identified by Educational Institutions and Public Institutes
of Research (IEIPP) and Companies and Private Research Institutes (EIPP).
Conclusion:
The analysis of patents made it possible to characterize the natural products used in
the treatment of arthritis, with emphasis on botanical extracts (71%), as a single component, as
well as in association with other botanical extracts, isolated compounds and minerals.
Collapse
Affiliation(s)
| | | | - Sara M. Thomazzi
- Department of Physiology, University of Sergipe, Sao Cristovao, Brazil
| |
Collapse
|
11
|
Sharma C, Whittle S, Haghighi PD, Burstein F, Sa'adon R, Keen HI. Mining social media data to investigate patient perceptions regarding DMARD pharmacotherapy for rheumatoid arthritis. Ann Rheum Dis 2020; 79:1432-1437. [PMID: 32883653 PMCID: PMC7569383 DOI: 10.1136/annrheumdis-2020-217333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES We hypothesise that patients have a positive sentiment regarding biological/targeted synthetic disease modifying anti-rheumatic drugs (b/tsDMARDs) and a negative sentiment towards conventional synthetic agents (csDMARDs). We analysed discussions on social media platforms regarding DMARDs to understand the collective sentiment expressed towards these medications. METHODS Treato analytics were used to download all available posts on social media about DMARDs in the context of rheumatoid arthritis. Strict filters ensured that user generated content was downloaded. The sentiment (positive or negative) expressed in these posts was analysed for each DMARD using sentiment analysis. We also analysed the reason(s) for this sentiment for each DMARD, looking specifically at efficacy and side effects. RESULTS Computer algorithms analysed millions of social media posts and included 54 742 posts about DMARDs. We found that both classes had an overall positive sentiment. The ratio of positive to negative posts was higher for b/tsDMARDs (1.210) than for csDMARDs (1.048). Efficacy was the most commonly mentioned reason in posts with a positive sentiment and lack of efficacy was the most commonly mentioned reason for a negative sentiment. These were followed by the presence/absence of side effects in negative or positive posts, respectively. CONCLUSIONS Public opinion on social media is generally positive about DMARDs. Lack of efficacy followed by side effects were the most common themes in posts with a negative sentiment. There are clear reasons why a DMARD generates a positive or negative sentiment, as the sentiment analysis technology becomes more refined, targeted studies could be done to analyse these reasons and allow clinicians to tailor DMARDs to match patient needs.
Collapse
Affiliation(s)
- Chanakya Sharma
- Rheumatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Samuel Whittle
- Rheumatology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
| | | | - Frada Burstein
- Information Technology, Monash University, Clayton, Victoria, Australia
| | | | - Helen Isobel Keen
- Medicine and Pharmacology, UWA, Murdoch, Western Australia, Australia
| |
Collapse
|
12
|
A theory-based intervention to promote medication adherence in patients with rheumatoid arthritis: A randomized controlled trial. Clin Rheumatol 2020; 40:101-111. [PMID: 32588274 PMCID: PMC7782392 DOI: 10.1007/s10067-020-05224-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/16/2020] [Accepted: 06/08/2020] [Indexed: 12/04/2022]
Abstract
Introduction/objectives Adherence to prescribed medication regimens is fundamental to the improvement and maintenance of the health of patients with rheumatoid arthritis. It is therefore important that interventions are developed to address this important health behavior issue. The aim of the present study was to design and evaluate a theory-based intervention to improve the medication adherence (primary outcome) among rheumatoid arthritis patients. Methods The study adopted a pre-registered randomized controlled trial design. Rheumatoid arthritis patients were recruited from two University teaching hospitals in Qazvin, Iran from June 2018 to May 2019 and randomly assigned to either an intervention group (n = 100) or a treatment-as-usual group (n = 100). The intervention group received a theory-based intervention designed based on the theoretical underpinnings of the health action process approach (HAPA). More specifically, action planning (making detailed plans to follow medication regimen), coping planning (constructing plans to overcome potential obstacles that may arise in medication adherence), and self-monitoring (using a calendar to record medication adherence) of the HAPA has been used for the treatment. The treatment-as-usual group received standard care. Results Data analysis was conducted based on the principle of intention to treat. Using a linear mixed-effects model (adjusted for age, sex, medication prescribed, and body mass index), the results showed improved medication adherence scores in the intervention group (loss to follow-up = 16) compared to the treatment-as-usual group (loss to follow-up = 12) at the 3-month (coefficient = 3.9; SE = 0.8) and 6-month (coefficient = 4.5; SE = 0.8) follow-up. Intervention effects on medication adherence scores were found to be mediated by some of the theory-based HAPA variables that guided the study. Conclusion The results of the present study support the use of a theory-based intervention for improving medication adherence among rheumatoid arthritis patients, a group at-risk of not adhering to medication regimens. Trial registration (in Iranian Registry of Clinical Trials) irct.ir, IRCT20180108038271N1Key Points • Theoretical underpinnings of the health action process approach are useful to improve medication adherence for RA patients. |
Electronic supplementary material The online version of this article (10.1007/s10067-020-05224-y) contains supplementary material, which is available to authorized users.
Collapse
|
13
|
Tolu S, Rezvani A, Karacan İ, Bugdayci D, Küçük HC, Bucak ÖF, Aydin T. Self-Reported Medication Adherence in Patients With Ankylosing Spondylitis: The Role of Illness Perception and Medication Beliefs. Arch Rheumatol 2020; 35:495-505. [PMID: 33758806 PMCID: PMC7945695 DOI: 10.46497/archrheumatol.2020.7732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/14/2019] [Indexed: 01/30/2023] Open
Abstract
Objectives
This study aims to investigate medication adherence in Turkish patients with ankylosing spondylitis (AS) and analyze the related factors for non-adherence. Patients and methods
Ninety-nine patients with AS (60 males, 39 females; mean age 41.3±8.4 years; range, 18 to 66 years) were included in the study. Sociodemographic and clinical data were collected. Disease activity (Bath Ankylosing Spondylitis Disease Activity Index, C-reactive protein, and erythrocyte sedimentation rate), functional status (Bath Ankylosing Spondylitis Functional Index), spinal pain and fatigue (visual analog scale), quality of life (Ankylosing Spondylitis Quality of Life), and depression and anxiety (Hospital Anxiety and Depression Scale) were evaluated. Adherence to anti-rheumatic drugs was elicited using the Compliance Questionnaire on Rheumatology (CQR). Medication beliefs were assessed using the Beliefs about Medicines Questionnaire (BMQ), and illness perception using the Brief Illness Perception Questionnaire (B-IPQ). Results
Non-adherence was reported in 64 patients (64.6%). No significant relationship between demographic, clinical, or psychological factors and adherence was found, except for disease duration (p=0.031). High B-IPQ treatment follow-up, illness coherence, and BMQ-Specific necessity scores were associated with good adherence (p=0.007, p=0.039, and p=0.002, respectively). BMQ-General overuse and harm scores showed an inverse correlation with the CQR score (p=0.005 r=-0.278; p=0.029 r=-0.219, respectively). Longer disease duration [odds ratio (OR): 0.98, 95% confidence interval (CI): 0.97-0.99] and higher B-IPQ item-1 score regarding the effect of the illness on the individual's life (OR: 0.58, 95% CI: 0.42- 0.81) were important predictors of low adherence. Conclusion Nearly three out of five AS patients were identified as at risk for non-adherence with the CQR. Medication adherence is influenced by the patient’s beliefs about medicines and illness perceptions, and these may be key targets for future interventions to improve medication adherence.
Collapse
Affiliation(s)
- Sena Tolu
- Department of Physical Medicine and Rehabilitation, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Aylin Rezvani
- Department of Physical Medicine and Rehabilitation, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - İlhan Karacan
- Department of Physical Medicine and Rehabilitation, Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Derya Bugdayci
- Department of Physical Medicine and Rehabilitation, Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Habib Can Küçük
- Department of Physical Medicine and Rehabilitation, Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Ömer Faruk Bucak
- Department of Physical Medicine and Rehabilitation, Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Turkey
| | - Teoman Aydin
- Department of Physical Medicine and Rehabilitation, Bezmialem Vakıf University Faculty of Medicine, Istanbul, Turkey
| |
Collapse
|
14
|
Michaud K, Vrijens B, Tousset E, Pedro S, Schumacher R, Dasic G, Chen C, Agarwal E, Suarez-Almazor ME. Real-World Adherence to Oral Methotrexate Measured Electronically in Patients With Established Rheumatoid Arthritis. ACR Open Rheumatol 2019; 1:560-570. [PMID: 31777840 PMCID: PMC6858035 DOI: 10.1002/acr2.11079] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 08/16/2019] [Indexed: 12/21/2022] Open
Abstract
Objective To assess methotrexate (MTX) adherence using the Medication Event Monitoring System (MEMS) and characterize associations with adherence in patients with rheumatoid arthritis (RA). Methods Eligible patients participated in Forward, the National Databank for Rheumatic Diseases, and recently (12 months or sooner) initiated oral MTX. MEMS was used to compile MTX weekly dosing over 24 weeks. The Beliefs about Medicines Questionnaire (BMQ) was completed, and baseline demographics and disease characteristics obtained. MTX adherence (percentage of weeks dose taken correctly), implementation (percentage of weeks dose taken correctly from initiation until last dose), and persistence (duration from initiation to last dose) were calculated. Analyses measured associations between patient characteristics and adherence, modeled using logistic generalized estimating equations and censored Poisson regression, and persistence modeled using Cox regression. Results Overall, 60 of 119 eligible patients were included in the analysis. MTX adherence, implementation, and persistence were 75%, 80%, and 83%, respectively, at 24 weeks. Demographics and disease characteristics were generally similar between patients with 1 week or less and 2 weeks or more of missed MTX. Unemployment, less disability, higher Patient Global scores, and no prior disease‐modifying antirheumatic drug (DMARD) use were associated with correct dosing. No significant differences in adherence were observed between patients receiving concomitant MTX versus MTX monotherapy, and biologic DMARD‐experienced versus biologic DMARD‐naïve patients. Higher scores in BMQ Specific Necessity (indicating a greater belief in the necessity of the medication) was associated with a decreased likelihood of dosing at an interval shorter than prescribed (odds ratio 0.89). Conclusion Even in a participatory group over a short period, MTX adherence was suboptimal and associated with certain demographics, medication experience, and beliefs about medicines. This suggests a need for screening and alternative treatment opportunities in nonadherent MTX patients with RA.
Collapse
Affiliation(s)
- Kaleb Michaud
- University of Nebraska Medical Center, Omaha, Nebraska and Forward, The National Databank for Rheumatic Diseases Wichita Kansas
| | - Bernard Vrijens
- AARDEX Group, Visé, Belgium, and University of Liège Liège Belgium
| | | | - Sofia Pedro
- Forward, The National Databank for Rheumatic Diseases Wichita Kansas
| | | | | | | | | | | |
Collapse
|
15
|
Gomides APM, de Albuquerque CP, Santos ABV, Amorim RBC, Bértolo MB, Júnior PL, Santos IA, Giorgi RDN, Sacilotto NDC, Radominski SC, Borghi FM, Guimarães MFBR, Pinto MRDC, Resende GG, Bonfiglioli KR, da Silva HC, Sauma MDFLDC, Sauma ML, de Medeiros JB, Pereira IA, de Castro GRW, Brenol CV, Xavier RM, da Mota LMH, Pinheiro GDRC. Causes of synthetic disease-modifying drug discontinuation in rheumatoid arthritis: Data from a large real-life cohort. PLoS One 2019; 14:e0213219. [PMID: 30822348 PMCID: PMC6396919 DOI: 10.1371/journal.pone.0213219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/15/2019] [Indexed: 02/07/2023] Open
Abstract
The treatment of rheumatoid arthritis (RA) has evolved rapidly in recent years. Nonetheless, conventional synthetic disease-modifying drugs (csDMARDs) remain the gold standard for RA treatment. The treatment for RA is expensive and this has a negative impact on public health. Given the low cost of csDMARDs compared to those of other treatment strategies, it is important to manage this type of treatment properly. Information on the duration of use of each drug and the reasons for their discontinuation is relevant to medical practitioners as it could improve the information available regarding side effects and their proper management. Moreover, data from clinical practice in the population can provide health care managers with information for resource allocation and optimization of csDMARD use with a consequent cost reduction in the treatment of RA. In this cross-sectional study, we aimed to describe the use of csDMARDs in public health services in Brazil, emphasizing on the duration of use and reasons for discontinuation of each drug. This study is a part of the REAL, a multicenter project that evaluated Brazilian patients with RA from eleven rheumatology services from August to October 2015. Patients were examined clinically, and an analysis of complementary exams and medical records was performed. A total of 1125 patients were included. 98.5% were women with a median age of 55.6 years. 36% and 90.84% patients were using biological disease-modifying drugs (bDMARDs) and csDMARDs, respectively. The duration of use and doses of each medication and the causes of suspension were analyzed. Most of the patients analyzed in this study were using csDMARDs for prolonged periods and methotrexate showed the longest duration of use. Interruption indexes due to ineffectiveness and side effects were analyzed. The knowledge of common adverse effects may alert attending physicians to the proper management of effective and low-cost therapeutic groups.
Collapse
Affiliation(s)
- Ana Paula Monteiro Gomides
- Departamento de Reumatologia, Universidade de Brasília, Brasília, Distrito Federal, Brazil
- Departamento do curso de Medicina, Centro Universitário de Brasília- Uniceub, Brasília, Distrito Federal, Brazil
- * E-mail:
| | | | - Ana Beatriz Vargas Santos
- Departamento de Reumatologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Manoel Barros Bértolo
- Departamento de Reumatologia, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
| | - Paulo Louzada Júnior
- Departamento de Reumatologia, Faculdade de Medicina da Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Isabela Araújo Santos
- Departamento de Reumatologia, Faculdade de Medicina da Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rina Dalva Neubarth Giorgi
- Departamento de Reumatologia, Instituto de Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual de São Paulo, São Paulo, São Paulo, Brazil
| | - Nathalia de Carvalho Sacilotto
- Departamento de Reumatologia, Instituto de Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Fernanda Maria Borghi
- Departamento de Reumatologia, Universidade Estadual de Maringá, Maringá, Paraná, Brazil
| | | | | | - Gustavo Gomes Resende
- Departamento de Reumatologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | - Marcel Lobato Sauma
- Departamento de Reumatologia, Universidade Federal do Pará, Belém, Pará, Brazil
| | | | - Ivânio Alves Pereira
- Departamento de Reumatologia, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - Claiton Viegas Brenol
- Departamento de Reumatologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ricardo Machado Xavier
- Departamento de Reumatologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | |
Collapse
|
16
|
Oh YJ, Park B, Moon KW. Effect of Drug Adherence on Treatment Outcome in Rheumatoid Arthritis. JOURNAL OF RHEUMATIC DISEASES 2019. [DOI: 10.4078/jrd.2019.26.4.264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yoon-Jeong Oh
- Division of Rheumatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
- Office of Biostatistics, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Korea
| | - Ki Won Moon
- Division of Rheumatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| |
Collapse
|
17
|
Nakagawa S, Nakaishi M, Hashimoto M, Ito H, Yamamoto W, Nakashima R, Tanaka M, Fujii T, Omura T, Imai S, Nakagawa T, Yonezawa A, Imai H, Mimori T, Matsubara K. Effect of medication adherence on disease activity among Japanese patients with rheumatoid arthritis. PLoS One 2018; 13:e0206943. [PMID: 30388179 PMCID: PMC6214559 DOI: 10.1371/journal.pone.0206943] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/21/2018] [Indexed: 11/19/2022] Open
Abstract
For the optimum efficacy of disease-modifying anti-rheumatic drugs (DMARDs), patients need to be adherent to their medication regimen. To clarify the effects of medication adherence on disease activity in Japanese patients with rheumatoid arthritis (RA), we conducted a cohort study in patients with various stages of RA. Patients were enrolled from the Kyoto University RA Management Alliance cohort, and followed up prospectively for 12 months. In this study, a total of 475 patients were analyzed and divided into 9 groups according to their medication adherence and the RA disease duration. The primary outcomes were based on the rate of a disease flare. The secondary outcomes were the changes in disease activity score using 28 joints (DAS28-ESR), simplified disease activity index (SDAI) and physical disability by health assessment questionnaire-disability index (HAQ). The changes in DAS28-ESR, HAQ, and the risk of disease flare in the highly adherent patients were significantly lower than those of the less adherent patients among the groups with RA ≤ 4.6 years but not those among the other groups. Taken together, this study identified a significant association between medication adherence and the disease flare during early-stage RA or short disease duration. These results emphasize the need to pay more attention to medication adherence in preventing the disease progression of RA.
Collapse
Affiliation(s)
- Shunsaku Nakagawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
- * E-mail:
| | - Mayumi Nakaishi
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Motomu Hashimoto
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Wataru Yamamoto
- Department of Health Information Management, Kurashiki Sweet Hospital, Kurashiki, Japan
| | - Ran Nakashima
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masao Tanaka
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takao Fujii
- Department of Clinical Immunology and Rheumatology, Wakayama Medical University, Wakayama, Japan
| | - Tomohiro Omura
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Satoshi Imai
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Takayuki Nakagawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Atsushi Yonezawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Hirohisa Imai
- Graduate School of Medicine, Department of Medical and Pharmaceutical Community Healthcare, the University of Tokyo, Tokyo, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuo Matsubara
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| |
Collapse
|
18
|
Costedoat-Chalumeau N, Tamirou F, Piette JC. Treatment adherence in systemic lupus erythematosus and rheumatoid arthritis: time to focus on this important issue. Rheumatology (Oxford) 2018; 57:1507-1509. [PMID: 28968691 DOI: 10.1093/rheumatology/kex337] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2017] [Indexed: 01/24/2023] Open
Affiliation(s)
- Nathalie Costedoat-Chalumeau
- Université René Descartes Paris, V; Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile de France, Service de médecine interne Pôle médecine, Hôpital Cochin, AP-HP, 27 rue du Faubourg Saint Jacques, Paris cedex 14, France.,INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | - Farah Tamirou
- Service de Rhumatologie, Cliniques Universitaires Saint-Luc, 10 avenue Hippocrate, 1200 Bruxelles, Belgique; Pôle de pathologies rhumatismales inflammatoires et systémiques, Institut de Recherche Expérimentale et clinique, Université catholique de Louvain, France
| | - Jean-Charles Piette
- AP-HP, Service de Médecine Interne, Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile de France, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France, France
| |
Collapse
|
19
|
Kim D, Choi JY, Cho SK, Choi CB, Bang SY, Cha HS, Choe JY, Chung WT, Hong SJ, Kim TH, Kim TJ, Koh E, Lee HS, Lee J, Lee SS, Lee SW, Park SH, Shim SC, Yoo DH, Yoon BY, Bae SC, Sung YK. Prevalence and Associated Factors for Non-adherence in Patients with Rheumatoid Arthritis. JOURNAL OF RHEUMATIC DISEASES 2018. [DOI: 10.4078/jrd.2018.25.1.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Dam Kim
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
| | | | - Soo-Kyung Cho
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
| | - Chan-Bum Choi
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
| | | | - Hoon-Suk Cha
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Yoon Choe
- Catholic University of Daegu School of Medicine, Daegu, Korea
| | | | | | - Tae-Hwan Kim
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Tae-Jong Kim
- Chonnam National University Hospital, Gwangju, Korea
| | - Eunmi Koh
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Jisoo Lee
- Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Shin-Seok Lee
- Chonnam National University Hospital, Gwangju, Korea
| | | | - Sung-Hoon Park
- Catholic University of Daegu School of Medicine, Daegu, Korea
| | | | - Dae-Hyun Yoo
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
| | - Yoon-Kyoung Sung
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Li L, Cui Y, Yin R, Chen S, Zhao Q, Chen H, Shen B. Medication adherence has an impact on disease activity in rheumatoid arthritis: a systematic review and meta-analysis. Patient Prefer Adherence 2017; 11:1343-1356. [PMID: 28831245 PMCID: PMC5553350 DOI: 10.2147/ppa.s140457] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Disease activity of rheumatoid arthritis (RA) patients was often measured by the 28-joint count disease activity score (DAS-28), which consists of 28 swollen and tender joint counts, patient's assessment of disease activity (visual analog scale [VAS]) and erythrocyte sedimentation rate. C-reactive protein was also used to measure disease activity in RA patients. The aim was to explore the impact of medication adherence on disease activity in patients with RA. METHODS A systematic search was performed in major electronic databases (PubMed, Web of Science, the Cochrane Library, CNKI, VIP and Wan fang) to identify studies reporting medication adherence and disease activity in RA patients. Results were expressed as mean difference (MD) and 95% CI. RESULTS A total of seven identified studies matched the inclusion criteria, reporting on a total of 1,963 adult RA patients in the analysis. The total score of DAS-28 was significantly lower in adherent patients than in nonadherent subjects (MD =-0.42, 95% CI [-0.80, -0.03], P=0.03). Similarly, a significant difference was observed between medication adherent and nonadherent groups in erythrocyte sedimentation rate (MD =-7.39, 95% CI [-11.69, -3.08], P<0.01) and tender joint count (MD =-1.29, 95% CI [-2.51, -0.06], P=0.04). Interestingly, the results of the meta-analysis showed no significant difference between medication adherent and nonadherent patients in swollen joint count (MD =-0.16, 95% CI [-2.13, 1.80], P=0.87), visual analog scale (MD =1.41, 95% CI [-3.68, 6.50], P=0.59) and C-reactive protein (MD =0.35, 95% CI [-0.64, 1.34], P=0.49). CONCLUSION The study suggests that RA patients with higher medication adherence tended to have lower disease activity.
Collapse
Affiliation(s)
- Lin Li
- Department of Nursing, The Second Affiliated Hospital of Nantong University, Nantong, China
- School of Nursing, Nantong University, Nantong, China
| | - Yafei Cui
- School of Nursing, Nantong University, Nantong, China
| | - Rulan Yin
- Department of Emergency ICU, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shengnan Chen
- School of Nursing, Nantong University, Nantong, China
| | - Qian Zhao
- School of Nursing, Nantong University, Nantong, China
| | - Haoyang Chen
- Department of Nursing, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Biyu Shen
- Department of Nursing, The Second Affiliated Hospital of Nantong University, Nantong, China
- Correspondence: Biyu Shen, Department of Nursing, The Second Affiliated Hospital of Nantong University, 6th Haier Lane Road, 2 26 001 Nantong, China, Tel +86 138 6293 7317, Email
| |
Collapse
|