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Bessette L, Florica B, Naik L, Sholter D, Fournier PA, Girard T, Liazoghli D, Baer PA. A Canadian Retrospective Chart Review Evaluating Concomitant Methotrexate De-escalation Patterns in Patients with Rheumatoid Arthritis Treated with Biologic or Targeted Synthetic DMARDs. Rheumatol Ther 2024:10.1007/s40744-024-00696-9. [PMID: 38976169 DOI: 10.1007/s40744-024-00696-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/20/2024] [Indexed: 07/09/2024] Open
Abstract
INTRODUCTION Rheumatoid arthritis (RA) guidelines recommend methotrexate (MTX)-anchored therapy with biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs); however, tolerability issues often lead to non-adherence. Canadian data on MTX tapering and/or withdrawal following b/tsDMARD initiation are minimal. This chart review assessed frequency of MTX tapering or withdrawal following b/tsDMARD initiation and the impact on disease status in Canadian adults with RA. METHODS Eligible patients had received MTX for ≥ 3 months before b/tsDMARD initiation. The b/tsDMARD was prescribed continuously for ≥ 18 months. Patients taking > 10 mg/day oral prednisone or equivalent were excluded. RESULTS Eight hundred eighty-nine patients (mean baseline MTX dose 19.0 mg/week) prescribed b/tsDMARDs (tumor necrosis factor inhibitor 52.1%, Janus kinase inhibitor 18.3%, interleukin-6 inhibitor [IL-6i] 11.9%, other 17.7%) were evaluated at 22 Canadian centers. Within 2 years of b/tsDMARD initiation, MTX was tapered in 123 (13.8%) patients and discontinued in 147 (16.5%), most commonly due to planned tapering (36.6%) and patient decision (27.2%), respectively, and most commonly with IL-6i use (34.9%). The MTX dose was unchanged for 582 (65.5%) patients and increased for 37 (4.2%). Missing data limit interpretations of MTX dose effects on some secondary endpoints and challenge the assertion that a disease activity measure-based treat-to-target approach is routinely used in Canadian rheumatology practice. CONCLUSIONS Methotrexate tapering or withdrawal occurred in 30.4% of Canadians with RA within 2 years following b/tsDMARD initiation. Baseline disease activity measures were missing from many medical records. However, for patients with baseline assessments, MTX tapering or discontinuation did not worsen disease activity.
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Affiliation(s)
- Louis Bessette
- Groupe de Recherche en Maladies Osseuses Inc., Québec City, QC, Canada
| | - Brandusa Florica
- Brandusa Florica Medicine Professional Corporation, Mississauga, ON, Canada
| | - Latha Naik
- Dr. Latha Naik Medicine Professional Corporation, Saskatoon, SK, Canada
| | | | | | | | | | - Philip A Baer
- Baer Weinberg MPC, 1003-131 Beecroft Road, North York, ON, M2N 6G9, Canada.
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Théate N, Geoffroy M, Kanagaratnam L, Gozalo C, Charlot I, Bolko L, Hittinger-Roux A, Djerada Z, Salmon JH. Urinary methotrexate dosage in rheumatoid arthritis, in patients treated for at least 6 months: a potential marker of adherence. RMD Open 2024; 10:e004024. [PMID: 38772677 DOI: 10.1136/rmdopen-2023-004024] [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: 12/18/2023] [Accepted: 04/28/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVES Non-adherence to rheumatoid arthritis (RA) treatments must be identified. A methotrexate (MTX) urinary dosage (METU) was recently developed. The aim of our study was to assess adherence to MTX in RA using METU in real-life conditions and to compare it with indirect adherence measurement technics. METHODS We performed a cross-sectional study at Reims University Hospital. We included over 18-year-old patients with RA treated by MTX for more than 6 months. Patients were invited to complete demographic, clinical and psychological questionnaires and adherence measurement technics (Compliance Questionnaire of Rheumatology (CQR) and Medication Possession Ratio (MPR)). A urinary sample was collected to measure MTX and information about tolerance was evaluated through Methotrexate Intolerance Severity Score. RESULTS 84 patients were included, 26 using oral MTX, 58 subcutaneous (SC) MTX. Among them, 73% were female, mean age was 61.5 years, MTX mean dose was 15 mg/week and 61.9% were treated by biological DMARDs (Disease Modifying Antirheumatic Drugs). 77 patients (91.7%) were adherent to treatment according to METU, whereas MPR and CQR reported less adherence (69.5% and 61.9%, respectively). MPR and METU were not significantly different in SC MTX users (p=0.059). Non-adherent patients had a higher number of tender joints and C reactive protein value (p<0.05). CONCLUSION This is the first largest study evaluating MTX adherence in patients with RA using a urinary dosage. We identified that indirect adherence measurements did not reflect real-life adherence. It would be appreciable to realise METU, in a new study, in patients with RA with unexplained response to treatment, to consider it before escalating therapeutic strategy.
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Affiliation(s)
- Noémie Théate
- Rhumatologie, Université de Reims Champagne-Ardenne, Reims, France
- Rhumatologie, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Marion Geoffroy
- Rhumatologie, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Lukshe Kanagaratnam
- UR 3797 VieFra, Université de Reims Champagne-Ardenne, Reims, France
- Unité d'Aide Méthodologique, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Claire Gozalo
- UR 3801 PPF, Université de Reims Champagne-Ardenne, Reims, France
- Pharmacologie-Toxicologie, Pôle de Biologie Territoriale, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Isabelle Charlot
- Rhumatologie, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Lois Bolko
- Rhumatologie, Centre Hospitalier Universitaire de Reims, Reims, France
| | | | - Zoubir Djerada
- UR 3801 PPF, Université de Reims Champagne-Ardenne, Reims, France
- Pharmacologie-Toxicologie, Pôle de Biologie Territoriale, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Jean-Hugues Salmon
- Rhumatologie, Université de Reims Champagne-Ardenne, Reims, France
- Rhumatologie, Centre Hospitalier Universitaire de Reims, Reims, France
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Müller-Ladner U, Edwards CJ, Erkens A. International Survey to Evaluate Current Options for Subcutaneous Injection of Methotrexate (MTX) and a New Button-Free MTX Autoinjector. Patient Prefer Adherence 2024; 18:579-590. [PMID: 38463400 PMCID: PMC10924829 DOI: 10.2147/ppa.s440818] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
Purpose Prefilled syringes (PFS) and various types of pens are available for subcutaneous injection of methotrexate (MTX) in patients with rheumatoid arthritis or moderate to severe psoriasis. A new MTX pen with modernized button-free autoinjection technology was developed as a successor to a button-activated pen (metoject®/metex® PEN). To assess the needs of users and the relevance of features of the new MTX autoinjector an international online survey was performed. Methods A structured questionnaire was distributed to physicians, nurses and patients in Germany, France, and the United Kingdom. Participants received illustrations and information about features of the new MTX autoinjector. Results In total, 189 rheumatologists, 111 dermatologists, 90 nurses, and 180 patients answered the questions. Specific reasons for a preference for the use of MTX pens over PFS could predominantly be assigned to the categories "dosing/administration" and "ease of use". The first impression of the new MTX autoinjector was positive in 82% of physicians, 87% of nurses, and 76% of patients, respectively. The four most important features of the new MTX autoinjector were 2-step autoinjector mechanism (receiving a mean 14.1 to 18.1 chips of a total of 100 chips), small injection volume (9.7 to 11.7 chips), 10 different doses for dose flexibility (8.0 to 13.2 chips), and short injection time below 5 seconds (8.5 to 11.1 chips). Conclusion Arguments for the use of MTX pens as opposed to PFS predominantly refer to dosing/administration and ease of use. The new button-free MTX autoinjector combines a number of advantageous features identified by the international survey.
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Affiliation(s)
- Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig-University Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Christopher J Edwards
- Musculoskeletal Research Unit, NIHR Southampton Clinical Research Facility, University Hospital Southampton, Southampton, UK
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4
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Hebing RCF, Elhendy N, van Geel EH, van Heuckelum M, Nurmohamed MT, van den Bemt BJF. The correlation between 4 adherence measurements methods in patients with rheumatoid arthritis using methotrexate. Br J Clin Pharmacol 2024; 90:882-889. [PMID: 38048762 DOI: 10.1111/bcp.15980] [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: 04/20/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023] Open
Abstract
AIMS Methotrexate (MTX) is the cornerstone in the treatment of rheumatoid arthritis (RA) patients. However, adherence to MTX therapy is not optimal, and instruments to assess medication nonadherence are warranted. To date there is no consensus on the best method to determine adherence to MTX. The aim of this study was to assess the correlation between adherence assessed with a Medication Event Monitoring System (MEMS) vs. pill count, MTX-polyglutamate (PG) concentration and Compliance Questionnaire-Rheumatology (CQR) in patients with established RA. Second, the correlations between these methods and the Disease Activity Scores of 28 joints (DAS28) were examined. METHODS Adult RA patients currently treated with MTX were included. Multivariable linear and logistic regression were used, with adherence assessed with MEMS as dependent variable vs. pill count, MTX-PG concentrations, CQR as independent variables and DAS28 vs. each of the 4 adherence measurements. Covariates were included, such as comedication, age and use of corticosteroids. RESULTS In total, 190 consecutive RA patients were included. Pill count was correlated with adherence assessed with MEMS (linear regression, β = 0.588, 95% confidence interval = 0.255-0.921, P < .001), whereas CQR and MTX-PGs were not. Logistic regression confirmed the correlation between dichotomized adherence and pill count only (β = 4.47, 95% confidence interval = 1.31-7.64, P = .006). No other correlations were found, either for all adherence outcomes or DAS28. CONCLUSION Measuring adherence with MEMS is correlated with pill count, whereas other methods were not correlated with MEMS or with DAS28. Pill count can be used to estimate adherence to MTX therapy, in case MEMS is not achievable.
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Affiliation(s)
- Renske C F Hebing
- Amsterdam Rheumatology and immunology Center, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Amsterdam Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands
| | - Nada Elhendy
- Amsterdam Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands
| | - Eva H van Geel
- Amsterdam Rheumatology and immunology Center, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Amsterdam Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands
| | | | - Michael T Nurmohamed
- Amsterdam Rheumatology and immunology Center, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Amsterdam Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands
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5
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Chen CW, Walter P, Wei JCC. Using ChatGPT-Like Solutions to Bridge the Communication Gap Between Patients With Rheumatoid Arthritis and Health Care Professionals. JMIR MEDICAL EDUCATION 2024; 10:e48989. [PMID: 38412022 PMCID: PMC10933717 DOI: 10.2196/48989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 10/09/2023] [Accepted: 02/05/2024] [Indexed: 02/28/2024]
Abstract
The communication gap between patients and health care professionals has led to increased disputes and resource waste in the medical domain. The development of artificial intelligence and other technologies brings new possibilities to solve this problem. This viewpoint paper proposes a new relationship between patients and health care professionals-"shared decision-making"-allowing both sides to obtain a deeper understanding of the disease and reach a consensus during diagnosis and treatment. Then, this paper discusses the important impact of ChatGPT-like solutions in treating rheumatoid arthritis using methotrexate from clinical and patient perspectives. For clinical professionals, ChatGPT-like solutions could provide support in disease diagnosis, treatment, and clinical trials, but attention should be paid to privacy, confidentiality, and regulatory norms. For patients, ChatGPT-like solutions allow easy access to massive amounts of information; however, the information should be carefully managed to ensure safe and effective care. To ensure the effective application of ChatGPT-like solutions in improving the relationship between patients and health care professionals, it is essential to establish a comprehensive database and provide legal, ethical, and other support. Above all, ChatGPT-like solutions could benefit patients and health care professionals if they ensure evidence-based solutions and data protection and collaborate with regulatory authorities and regulatory evolution.
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Affiliation(s)
- Chih-Wei Chen
- National Applied Research Laboratories, Taipei, Taiwan
- National Council for Sustainable Development, Taipei, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Faculty of Engineering Sciences, University College London (UCL), London, United Kingdom
| | - Paul Walter
- National Applied Research Laboratories, Taipei, Taiwan
- Faculty of Pharmacy, Paris-Saclay University, Orsay, France
- Mines Saint-Etienne, Saint-Etienne, France
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
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Bharadwaj AD, Kravets S, Hallak J, Bhat P, Lobo-Chan AM. Patient Adherence to Immunosuppressive Therapy in Treatment of Chronic Inflammatory Eye Disease. Ocul Immunol Inflamm 2024; 32:5-10. [PMID: 36442053 DOI: 10.1080/09273948.2022.2145314] [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: 09/10/2022] [Accepted: 11/03/2022] [Indexed: 11/29/2022]
Abstract
TITLE Patient Adherence to Immunosuppressive Therapy for Chronic Inflammatory Eye Disease. PURPOSE To investigate adherence rates to immunosuppressive therapy (IMT) for treatment of noninfectious inflammatory eye disease (IED), adherence and disease control, and factors associated with nonadherence. METHOD Retrospective review of medical charts from 2015 to 2020 was conducted on patients with IED at 6 months, 1 and 2 years after initiation of IMT. RESULTS Of 183 patients, adherence rates at 6 months and 1 year were 70% and 58% by 2 years. Eighty-two percent, 78%, and 65% of patients with disease quiescence were adherent at 6 months, 1 and 2 years, respectively. Adherent patients have 1.86 (95% CI 1.09, 3.20) times greater likelihood for disease control compared to nonadherent. Primary reason for nonadherence was patient self-discontinuation. No specific factors were associated with nonadherence. CONCLUSION Patients on IMT for IED had steady adherence rates up to 1 year, with decreased adherence at 2 years. Adherence to IMT significantly correlates with disease quiescence.
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Affiliation(s)
- Arthi D Bharadwaj
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sasha Kravets
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Joelle Hallak
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
- AbbVie, North Chicago, Illinois, USA
| | - Pooja Bhat
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ann-Marie Lobo-Chan
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
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Marques A, Matos C, Nikiphorou E, Livermore P, Ferreira RJO. Towards a consensus for nurse education of methotrexate for people with rheumatic and musculoskeletal diseases: A scoping review. Musculoskeletal Care 2023; 21:1227-1237. [PMID: 37587575 DOI: 10.1002/msc.1804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Patient education (PE) is a key role of nurses, which includes providing information, training, and support about methotrexate (MTX), an anchor drug in rheumatology. However, there is a wide variation in the access to rheumatology nurse consultations in Europe, and there is a lack of consensus regarding the delivery, context and timing of PE in these cases. This study aimed to provide a comprehensive overview of the existing research on nurse education of MTX for children/youth and adults with Rheumatic and Musculoskeletal Diseases (RMDs). METHODS This scoping review was conducted in accordance with Arksey and O'Malley's framework. A search on PubMed (MEDLINE), Scopus and Cochrane Database, and CINAHL, from inception until March 2022 was conducted. Articles on PE with a focus on MTX exclusively were included. Published and unpublished studies, from any world region, conducted with a qualitative, quantitative, or mixed-methods design and focused on defined research questions, were eligible for inclusion. Broad inclusion criteria were used if a research paper on PE focused on MTX for people with RMDs (PE or patient engagement, self-management, medication knowledge, or health literacy in patients). The reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews (PRISMA-ScR) checklist. Two independent reviewers performed standardized data extraction and synthesis. RESULTS From 292 references identified, the total number of studies which met the inclusion criteria was relatively small (n = 14). The results identified that knowledge of MTX improves when education by nurses is provided. CONCLUSION This scoping review showed that there is no universal worldwide strategy for MTX education of children/youths and adults with RMDs. However, PE regarding MTX can be delivered in different forms, resulting in better satisfaction and adherence. More randomized controlled trials with powered samples are required.
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Affiliation(s)
- Andréa Marques
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra, Coimbra, Portugal
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Cristiano Matos
- Instituto Politécnico de Coimbra, Escola Superior de Tecnologia da Saúde de Coimbra, Coimbra, Portugal
- QLV Research Consulting, Coimbra, Portugal
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK
- Rheumatology Department, King's College Hospital, London, UK
| | - Polly Livermore
- Rheumatology Department, Great Ormond Street Children's Hospital, London, UK
- GOSH NIHR BRC, Institute of Child Health and University College London, London, UK
| | - Ricardo J O Ferreira
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra, Coimbra, Portugal
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- QLV Research Consulting, Coimbra, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisbon, Portugal
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Ceranic J, Kisic Tepavcevic D, Petronijevic M, Milic M, Ceranic M, Rancic N, Ristic G. Assessment and Prediction of Adherence to Methotrexate Using Three Self-Report Questionnaires in Patients with Rheumatoid Arthritis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1446. [PMID: 37629736 PMCID: PMC10456431 DOI: 10.3390/medicina59081446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/27/2023]
Abstract
Introduction: Methotrexate (MTX) reduces rheumatoid arthritis activity and ameliorates the long-term functional status in these patients. To achieve this aim, patients need to take their medication regularly. Nevertheless, non-adherence to MTX still remains a considerable issue in the management of rheumatoid arthritis. Objective: This study aimed to estimate the adherence to methotrexate in patients with rheumatoid arthritis and to identify specific non-adherence risk factors. Methods: A cross-sectional study included 111 patients (mean age 56.2 ± 10.6 years, 78.4% female, and mean disease duration 6 years (3-13)). Three adherence self-assessment questionnaires were used: the Compliance-Questionnaire-Rheumatology (CQR19), the Medication Adherence Reports Scale (MARS-5), and the Visual Analogue Scale (VAS). We also collected demographic data, disease and treatment characteristics, and anxiety/depression estimation results (Hospital Anxiety and Depression Scale, HADS). Results: Adherence was identified in 48.6% of patients (COR19), 70.3% of patients (MARS-5), and 82.9% of patients (VAS questionnaire). All three questionnaires displayed a significant positive mutual correlation: CQR19 with MARS-5 and VAS (r = 0.364, r = 0.329, respectively, p < 0.001 for both) and between the VAS and MARS-5 scores (r = 0.496, p < 0.001). A significant positive prediction was shown for urban residence (0.347 (0.134-0.901), p = 0.030) using the MARS-5, female sex (0.264 (0.095-0.730), p = 0.010) according to the CQR19, and for a dose of methotrexate (0.881 (0.783-0.992), p = 0.036) using the VAS, while negative predictions were shown for comorbidity number (3.062 (1.057-8.874), p = 0.039) and depression (1.142 (1.010-1.293), p = 0.035) using the MARS-5 and for older age (1.041 (1.003-1.081), p = 0.034) according to the CQR19. The use of steroids was a significant positive predictor in all three questionnaires and remained an independent predictor for methotrexate adherence in the multivariate logistic regression. Conclusions: We showed non-adherence to methotrexate in a significant number of patients using all three questionnaires. Concomitant steroid therapy emerged as an independent positive predictor for adherence.
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Affiliation(s)
- Jelena Ceranic
- Department of Rheumatology and Clinical Immunology, Military Medical Academy, 11040 Belgrade, Serbia; (M.P.); (G.R.)
- Faculty of Medicine, Institute of Epidemiology, University of Belgrade, 11000 Belgrade, Serbia;
| | - Darija Kisic Tepavcevic
- Faculty of Medicine, Institute of Epidemiology, University of Belgrade, 11000 Belgrade, Serbia;
| | - Milan Petronijevic
- Department of Rheumatology and Clinical Immunology, Military Medical Academy, 11040 Belgrade, Serbia; (M.P.); (G.R.)
- Faculty of Medicine of the Military Medical Academy, University of Defence, 11042 Belgrade, Serbia
| | - Marija Milic
- Faculty of Medicine, University of Pristina temporarily settled in Kosovska Mitrovica, 38220 Kosovska Mitrovica, Serbia;
| | - Milija Ceranic
- Department of Cardiology, Military Medical Academy, 11000 Belgrade, Serbia;
| | - Nemanja Rancic
- Faculty of Medicine of the Military Medical Academy, University of Defence, 11042 Belgrade, Serbia
- Centre for Clinical Pharmacology, Military Medical Academy, 11040 Belgrade, Serbia
| | - Gorica Ristic
- Department of Rheumatology and Clinical Immunology, Military Medical Academy, 11040 Belgrade, Serbia; (M.P.); (G.R.)
- Faculty of Medicine of the Military Medical Academy, University of Defence, 11042 Belgrade, Serbia
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Fleischmann R, Haraoui B, Buch MH, Gold D, Sawyerr G, Shi H, Diehl A, Lee K. Analysis of Disease Activity Metrics in a Methotrexate Withdrawal Study among Patients with Rheumatoid Arthritis Treated with Tofacitinib plus Methotrexate. Rheumatol Ther 2023; 10:375-386. [PMID: 36534208 PMCID: PMC10011257 DOI: 10.1007/s40744-022-00511-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/04/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The objective of this analysis was to assess disease activity metrics using a variety of disease outcome measures following methotrexate (MTX) withdrawal in ORAL Shift, a phase 3b/4 study of tofacitinib with/without MTX, in patients with rheumatoid arthritis (RA) achieving Clinical Disease Activity Index (CDAI)-defined low disease activity (LDA). METHODS Patients aged ≥ 18 years with active RA and an inadequate response to MTX received open-label tofacitinib modified-release 11 mg once daily plus MTX for 24 weeks. In the double-blind MTX withdrawal phase, those who had achieved CDAI LDA (≤ 10) at week 24 were randomised 1:1 to receive tofacitinib monotherapy or continued tofacitinib plus MTX. Efficacy analyses were performed in subgroups defined by whether remission and/or LDA had been achieved at week 24 with: Disease Activity Score in 28 joints, erythrocyte sedimentation rate [DAS28-4(ESR)], Routine Assessment of Patient Index Data 3 (RAPID3), CDAI and Simplified Disease Activity Index (SDAI); or DAS28-4[C-reactive protein(CRP)] < 2.4/ < 2.6/ < 2.9/ ≤ 3.2. RESULTS Five hundred and thirty patients received treatment in the double-blind MTX withdrawal phase. Proportions of patients achieving each disease activity criterion at week 24 varied by metric. Across disease activity metrics [excluding DAS28-4(ESR) remission], 58-89% of patients per group, and numerically more patients receiving tofacitinib plus MTX, achieved the same criterion at week 48 as at week 24. Differences between groups in least squares mean change from baseline (Δ) DAS28-4(ESR) from week 24-48 favoured tofacitinib plus MTX (nominal p values < 0.05). RAPID3 and DAS28-4(CRP) estimated a higher proportion of patients with acceptable disease state versus DAS28-4(ESR), CDAI remission and SDAI remission. CONCLUSION Response rates at the beginning of the double-blind phase varied across metrics. A consistent trend towards higher response rates with tofacitinib plus MTX was observed across metrics after randomisation, with nominal differences in DAS28-4(ESR) responses. Compared with continued combination therapy, MTX withdrawal did not lead to a clinically meaningful reduction in the response to tofacitinib. DAS28-4(CRP) and RAPID3 were the least stringent metrics. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02831855.
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Affiliation(s)
- Roy Fleischmann
- Metroplex Clinical Research Center and University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Boulos Haraoui
- Institut de Rhumatologie de Montréal, Montreal, QC Canada
| | - Maya H. Buch
- Centre for Musculoskeletal Research, University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester, UK
| | | | | | - Harry Shi
- Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426 USA
| | - Annette Diehl
- Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426 USA
| | - Kristen Lee
- Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426 USA
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Broadwell A, Schechtman J, Conaway D, Kivitz A, Shiff NJ, Black S, Xu S, Langholff W, Schwartzman S, Curtis JR. Effectiveness and safety of intravenous golimumab with and without concomitant methotrexate in patients with rheumatoid arthritis in the prospective, noninterventional AWARE study. BMC Rheumatol 2023; 7:5. [PMID: 36973741 PMCID: PMC10045110 DOI: 10.1186/s41927-023-00329-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Biologic therapies are often prescribed for patients with rheumatoid arthritis (RA) who have inadequate responses to or are intolerant of methotrexate (MTX) and patients with poor prognostic indicators. This post hoc analysis evaluated effectiveness and safety of intravenous golimumab + MTX vs golimumab without MTX in RA patients. METHODS AWARE, a real-world, prospective and pragmatic, Phase 4 study, compared effectiveness and safety of golimumab and infliximab in biologic-naïve and biologic-experienced patients. All treatment decisions were at the discretion of the treating rheumatologist. Effectiveness was evaluated by mean change in CDAI scores at Months 6 and 12. Safety was monitored through approximately 1 year. RESULTS Among 685 golimumab-treated patients, 420 (61%) received concomitant MTX during the study and 265 (39%) did not receive MTX after enrollment; 63% and 72%, respectively, discontinued the study. Relative to golimumab without MTX, golimumab + MTX patients had shorter mean disease duration (8.7 vs 10.0 years) and a lower proportion received prior biologics (60% vs 72%); mean ± standard deviation (SD) baseline CDAI scores were similar (30.8 ± 15.1 and 32.6 ± 15.4). Mean ± SD changes from baseline in CDAI scores at Months 6 and 12, respectively, were similar with golimumab + MTX (- 10.2 ± 14.2 and - 10.8 ± 13.8) and golimumab without MTX (- 9.6 ± 12.9 and - 9.9 ± 13.1). The incidence of adverse events/100 patient-years (PY) (95% confidence interval [CI]) was 155.6 (145.6, 166.1) for golimumab + MTX and 191.2 (176.2, 207.1) for golimumab without MTX; infections were the most common type. The incidence of infusion reactions/100PY (95% CI) was 2.1 (1.1, 3.6) for golimumab + MTX versus 5.1 (2.9, 8.3) for golimumab without MTX; none were considered serious. For golimumab + MTX versus golimumab without MTX, rates/100PY (95% CI) of serious infections, opportunistic infections, and malignancies were 2.6 (1.5, 4.3) versus 7.0 (4.4, 10.6), 0.9 (0.3, 2.0) versus 2.6 (1.1, 5.0), and 3.0 (1.7, 4.7) versus 1.0 (0.2, 2.8), respectively. CONCLUSIONS Mean change in CDAI score in the golimumab without MTX group was generally similar to that of the golimumab + MTX group through 1 year, regardless of prior biologic therapy. Adverse events were consistent with the known IV golimumab safety profile. These results provide real world evidential data that may assist healthcare providers and patients with RA in making informed treatment decisions. TRIAL REGISTRATION clinicaltrials.gov NCT02728934 05/04/2016.
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Affiliation(s)
- Aaron Broadwell
- Rheumatology and Osteoporosis Specialists, 820 Jordan Street, Suite 201, Shreveport, LA, 71101, USA.
| | | | | | - Alan Kivitz
- Altoona Center for Clinical Research, Duncansville, PA, USA
| | - Natalie J Shiff
- Janssen Scientific Affairs, LLC, Horsham, PA, USA
- Adjunct, Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Shawn Black
- Janssen Research and Development, LLC, Spring House, PA, USA
| | - Stephen Xu
- Janssen Research and Development, LLC, Spring House, PA, USA
| | - Wayne Langholff
- Janssen Research and Development, LLC, Spring House, PA, USA
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11
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Dhir V, Prasad CB, Kumar S, Kaul KK, Dung N, Naidu GSRSNK, Sharma SK, Sharma A, Jain S. Long-term persistence of oral methotrexate and associated factors in rheumatoid arthritis: a retrospective cohort study. Rheumatol Int 2023; 43:867-873. [PMID: 36933068 DOI: 10.1007/s00296-023-05305-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/02/2023] [Indexed: 03/19/2023]
Abstract
There is little data on long-term persistence/continuation of methotrexate among Indian Rheumatoid arthritis patients. We assembled a retrospective single-center cohort consisting of RA patients (fulfilling 1987 ACR criteria) started on methotrexate as part of three academic studies (including two RCTs) from 2011 to 2016. Oral methotrexate was started at 7.5 or 15 mg per week with a target dose of 25 mg per week. Between August and December 2020, all patients were contacted (telephonically) and data were obtained from clinic files to evaluate self-reported continuation/persistence of methotrexate and reasons for discontinuation. Survival analysis using Kaplan-Meier and cox-regression were used to assess methotrexate continuation rates and factors associated with its discontinuation. This study included 317 patients with rheumatoid arthritis, with mean age and disease duration (at enrollment) of 43 years and 2 years; And positive rheumatoid factor and anti-CCP in 69 and 75%. At follow-up, 16 patients (5%) had died, whereas 103 (32.5%) had discontinued methotrexate. On Kaplan-Meier survival analysis, the mean survival (continuation) time for methotrexate was 7.3 years (95% CI 7-7.6 years). The actuarial continuation/persistence of methotrexate at 3, 5 and 9 years was 92, 81 and 51%, respectively. Among those who discontinued methotrexate, common reasons were remission of disease, symptomatic adverse effects (intolerance), perceived lack of efficacy and socioeconomic reasons. On multivariable cox-regression, symptomatic adverse effects during the first 12-24 weeks (Hazard ratio, 95% CI 1.8 (1.2-2.8)) and anti-CCP positivity (Hazard ratio, 95% CI 0.6 (0.3-1.0)) were significantly associated with hazard of discontinuation. Persistence or continuation of methotrexate was found to be good and comparable to reports in other centers world-wide. Apart from remission, the most important cause of methotrexate discontinuation was symptomatic adverse effects (intolerance).
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Affiliation(s)
- Varun Dhir
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Chandra Bhushan Prasad
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sandeep Kumar
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Kavya Kriti Kaul
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Neha Dung
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - G S R S N K Naidu
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Shefali K Sharma
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Aman Sharma
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sanjay Jain
- Clinical Immunology and Rheumatology Unit, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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12
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Leon L, Madrid-Garcia A, Lopez-Viejo P, González-Álvaro I, Novella-Navarro M, Freites Nuñez D, Rosales Z, Fernandez-Gutierrez B, Abasolo L. Difficult-to-treat rheumatoid arthritis (D2T RA): clinical issues at early stages of disease. RMD Open 2023; 9:rmdopen-2022-002842. [PMID: 36889800 PMCID: PMC10008455 DOI: 10.1136/rmdopen-2022-002842] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/20/2023] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVES Most studies on difficult-to-treat rheumatoid arthritis (D2T RA) have focused on established RA. Here, we analyse whether disease activity in the early stages of RA could influence progression to a D2T RA under real-life conditions. Other clinical and treatment-related factors were also analysed. METHODS A longitudinal multicentre study of patients with RA was conducted from 2009 to 2018. Patients were followed up until January 2021. D2T RA was defined based on EULAR criteria (treatment failure, signs suggestive of currently active/progressive disease and management being perceived as problematic by the rheumatologist and/or patient). The main variable was disease activity in the early stages. The covariates were sociodemographic, clinical and treatment-related factors. We ran a multivariable logistic regression analysis to investigate risk factors associated with progression to D2T RA. RESULTS The study population comprised 631 patients and 35 (5.87%) developed D2T RA. At the time of diagnosis, the D2T RA group were younger, with a higher disability, 28-joint Disease Activity Score (DAS28) score, tender joint count and pain scores. In our final model, DAS28 was not statistically significantly associated with D2T RA. No differences were found between groups for therapy. Disability was independently associated with D2T RA (OR: 1.89; p=0.01). CONCLUSIONS In this cohort of patients newly diagnosed with RA, our results do not allow us to prove the influence of active disease according to DAS28. However, we did find that younger patients and those with elevated initial disability scores are more likely to develop D2T RA regardless of other factors.
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Affiliation(s)
- Leticia Leon
- IdISSC and Rheumatology, Hospital Clinico Universitario San Carlos, Madrid, Spain .,Health Sciences, Universidad Camilo Jose Cela, Villafranca del Castillo, Spain
| | | | | | | | | | | | - Zulema Rosales
- Rheumatology, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | | | - Lydia Abasolo
- IdISSC and Rheumatology, Hospital Clinico Universitario San Carlos, Madrid, Spain
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13
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Barton JL, Markwardt S, Niederhausen M, Schue A, Dougherty J, Katz P, Saha S, Yelin EH. Are We on the Same Page? A Cross-Sectional Study of Patient-Clinician Goal Concordance in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2023; 75:625-633. [PMID: 34569172 PMCID: PMC8957637 DOI: 10.1002/acr.24794] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/09/2021] [Accepted: 09/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patient-clinician goal concordance is associated with improved outcomes in certain chronic diseases but not explored in rheumatoid arthritis (RA). We examined goal concordance, correlates of concordance, and the association of concordance with health outcomes. METHODS Adult patients with RA seen at least 1 time in the prior 12 months at 1 of 2 rheumatology clinics participated. Patients and their clinicians independently ranked top 3 goals for RA treatment from 8 options before a routine visit. Patients completed postvisit surveys on health, demographic information, health literacy, and adherence. Goal concordance was defined as the patient's number 1 goal being among the clinician's top 3 goals for that patient. Bivariable and multivariable logistic regression models were used to examine correlates of concordance. RESULTS Patients were 58% female and 16% Spanish-speaking, and 29% had limited health literacy. Among 204 patient-clinician dyads, 20% were goal-discordant. "Have less pain" was selected by both patient and clinician in 81% of dyads, followed by "have fewer problems doing daily activities" by 63%. Otherwise, clinicians prioritized avoiding side effects, whereas patients ranked improved sleep, fatigue, and mood. Longer disease duration was associated with discordance (median 13.3 years, interquartile range [IQR] 5.2-20 among discordant vs. 7 years, IQR 4-14; P = 0.039); higher depressive symptoms were associated with concordance (8.1% vs. 24%; P = 0.04). Goal concordance was associated with higher medication adherence (adjusted odds ratio 2.76 [95% confidence interval 1.01, 7.56]). CONCLUSION One in 5 patient-clinician dyads had discordant treatment goals. Goal concordance was associated with higher medication adherence. Studies to improve goal elicitation and communication of patients with RA's priorities are needed.
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Affiliation(s)
- Jennifer L. Barton
- Center to Improve Veteran Involvement in Care/VA Portland Health Care System, Portland, OR
- Oregon Health & Science University, Portland, OR
| | | | - Meike Niederhausen
- Center to Improve Veteran Involvement in Care/VA Portland Health Care System, Portland, OR
- Oregon Health & Science University, Portland, OR
| | - Allison Schue
- Center to Improve Veteran Involvement in Care/VA Portland Health Care System, Portland, OR
| | - Jacob Dougherty
- Center to Improve Veteran Involvement in Care/VA Portland Health Care System, Portland, OR
| | - Patricia Katz
- University of California, San Francisco, San Francisco, CA
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care/VA Portland Health Care System, Portland, OR
- Oregon Health & Science University, Portland, OR
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14
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Beutner C, Schmitt J, Worm M, Wagenmann M, Albus C, Buhl T. Lack of Harmonized Adherence Criteria in Allergen Immunotherapy Prevents Comparison of Dosing and Application Strategies: A Scoping Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:439-448.e6. [PMID: 36272717 DOI: 10.1016/j.jaip.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 11/11/2022]
Abstract
Allergen immunotherapy (AIT) involves the application of increasing doses of allergen extract (as oral, sublingual, or subcutaneous immunotherapy) until immunologic tolerance is reached. Successful AIT relies on the consistent administration of allergen extract; therefore, adherence to these treatments is vital for compelling long-term results. Our review discusses the current terminology from adherence research in general, summarizes 25 current studies on adherence research in AIT in a scoping literature review, and delineates recommendations for tools and parameters for adherence research, aiming to improve outcomes in AIT. Almost every adherence study in AIT published to date used different tools, parameters, and data sources for measuring adherence and persistence rates. Unfortunately, an easily accessible, objective parameter or biomarker for monitoring treatment adherence and success has not yet been established for AIT. This situation calls for the development of an international core outcomes set for AIT that defines what is exactly meant by AIT adherence and how AIT adherence should be consistently measured. Therefore, we exemplarily present results and conclusions from adherence research in chronic diseases other than allergology. We aim to facilitate the development of advanced methods, considering the challenging disease specificities of these parameters in a routine care setting of AIT.
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Affiliation(s)
- Caroline Beutner
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany.
| | - Jochen Schmitt
- TU Dresden, Medizinische Fakultät Carl Gustav Carus, Center for Evidence-Based Healthcare, Dresden, Germany
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Venereology, and Allergology, Charité University Hospital Berlin, Berlin, Germany
| | - Martin Wagenmann
- Clinic of Otorhinolaryngology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
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15
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Meng CF, Rajesh DA, Jannat-Khah DP, Jivanelli B, Bykerk VP. Can Patients With Controlled Rheumatoid Arthritis Taper Methotrexate From Targeted Therapy and Sustain Remission? A Systematic Review and Metaanalysis. J Rheumatol 2023; 50:36-47. [PMID: 35970524 DOI: 10.3899/jrheum.220152] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine the risk of not being able to sustain remission after tapering methotrexate (MTX) from targeted therapy in patients with controlled rheumatoid arthritis (RA). METHODS A systematic literature search was conducted in MEDLINE, Embase, and the Cochrane Library for studies reporting remission outcomes after tapering MTX from targeted therapies in RA. Full-text articles and abstracts reported in English were included. Metaanalyses were conducted using random-effects models. Forest and funnel plots were created. RESULTS A total of 10 articles were included. Studies evaluated MTX being tapered from combination treatment with tumor necrosis factor inhibitors, tocilizumab, abatacept, and tofacitinib. A total of 9 studies used a randomized design and 1 was observational. Out of 10 studies, 3 focused on early RA (ie, < 1 yr). The MTX-tapering strategy was gradual in 2 studies and rapid in 8 studies. Follow-up ranged from 3 to 18 months in randomized trials and up to 3 years in the observational study. Our metaanalysis, which included 2000 participants with RA from 10 studies, showed that patients who tapered MTX from targeted therapy had a 10% reduction in the ability to sustain remission and an overall pooled risk ratio of 0.90 (95% CI 0.84-0.97). There was no heterogeneity (I 2 = 0%, P = 0.94). Our funnel plot indicated minimal publication bias. CONCLUSION Patients with controlled RA may taper MTX from targeted therapy with a 10% reduction in the ability to sustain remission for up to 18 months. Longer follow-up studies with attention to radiographic, functional, and patient-reported outcomes are needed. The risk of disease worsening should be discussed with the patient with careful follow-up and prompt retreatment of disease worsening.
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Affiliation(s)
- Charis F Meng
- C.F. Meng MD, V.P. Bykerk, MD, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medical College.
| | - Diviya A Rajesh
- D.A. Rajesh, BA, Division of Rheumatology, Hospital for Special Surgery
| | - Deanna P Jannat-Khah
- D.P. Jannat-Khah, DRPH, MSPH, Division of Rheumatology, Epidemiology and Biostatistics CORE, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medical College
| | - Bridget Jivanelli
- B. Jivanelli, MLIS, Kim Barrett Memorial Library, HSS Education Institute, Hospital for Special Surgery, New York, NY, USA
| | - Vivian P Bykerk
- C.F. Meng MD, V.P. Bykerk, MD, Division of Rheumatology, Hospital for Special Surgery, and Department of Medicine, Weill Cornell Medical College
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16
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Al-Saleh J, Almarzooqi A, Negm AA. Prevalence and Predictors of Remission and Sustained Remission in Patients with Rheumatoid Arthritis from the United Arab Emirates: A Two-Year Prospective Study. Open Access Rheumatol 2023; 15:51-63. [PMID: 37192954 PMCID: PMC10183195 DOI: 10.2147/oarrr.s408894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023] Open
Abstract
Aim To estimate the prevalence of remission and sustained remission for more than 12 months in a cohort of patients with rheumatoid arthritis in the United Arab Emirates and explore predictors of remission and sustained remission in these patients. Methods A two-year prospective study conducted in Dubai Hospital (January 1, 2018-December 31, 2019) included all consecutive patients with rheumatoid arthritis attending the rheumatology clinic. Patients with a Simplified Disease Activity Index ≤3.3 and/or Clinical Disease Activity Index ≤2.8 in December 2018 were considered in remission and followed until December 2019. Those who maintained remission through 2019 were considered in sustained remission. Results In this study, a total of 444 patients were followed for a 12-months period. The percentage of remission achieved in RA patients was 30.4% according to the Clinical Disease Activity Index, 31.1% according to Simplified Disease Activity Index, and 50.9% according to the Value of Disease Activity Score 28 (DAS28) remission criteria. The 12-months sustained remission rates ranged from 38.3% for the ACR-EULAR to 69.3% for the DAS28. Male gender, shorter disease duration, better functioning as evaluated by the Health Assessment Questionnaire Disability Index (lower HAQ scores), and higher compliance rates are among sustained remission predictors. Conclusion Establishing "real-world" data and understanding local predictors to sustained remission is principal for implementing timely and appropriate patient-tailored strategies. These strategies include early detection, close monitoring, and enhancing treatment adherence among UAE patients.
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Affiliation(s)
- Jamal Al-Saleh
- Rheumatology, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
- Correspondence: Jamal Al-Saleh, Rheumatology, Dubai Hospital, Dubai Health Authority, P.O. 7272, Dubai, United Arab Emirates, Tel +9714-219 5506, Fax +97142195788, Email
| | - Ahlam Almarzooqi
- Rheumatology, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Ahmed A Negm
- Rheumatology, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
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17
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Comparison of Biological Agent Monotherapy and Associations Including Disease-Modifying Antirheumatic Drugs for Rheumatoid Arthritis: Literature Review and Meta-Analysis of Randomized Trials. J Clin Med 2022; 12:jcm12010286. [PMID: 36615086 PMCID: PMC9821556 DOI: 10.3390/jcm12010286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Update the available evidence comparing biologic disease-modifying antirheumatic drugs (bDMARDs) in combination with conventional synthetic disease-modifying antirheumatic drugs (CsDMARDs) to bDMARDs in monotherapy in patients with rheumatoid arthritis. METHODS Research was limited to randomized controlled trials. Major outcome: ACR 20 response criteria at 24 weeks. SECONDARY OUTCOMES clinical and radiographic criteria at week 24, 52 and 104. RESULTS 23 trials (6358 patients), including seven bDMARDs and one other molecule: Anbainuo (anti-TNF-R). No study satisfied our search criteria for anakinra, certolizumab and infliximab. Compared to bDMARD monotherapy, combination therapy gives a better ACR 20 at 24 weeks (RR: 0.88 (0.84-0.94)) in fixed and random effect models, and this result is sustained at 52 and 104 weeks. The results were mostly similar for all other outcomes without increasing the risk of adverse effects. CONCLUSION This meta-analysis confirms the superiority of combination therapy over monotherapy in rheumatoid arthritis, in accordance to the usual guidelines.
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18
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Yajima N, Kawaguchi T, Takahashi R, Nishiwaki H, Toyoshima Y, Oh K, Odai T, Kanai T, Morisky DE, Yamaguchi T, Kasama T. Adherence to methotrexate and associated factors considering social desirability in patients with rheumatoid arthritis: a multicenter cross-sectional study. BMC Rheumatol 2022; 6:75. [PMID: 36527156 PMCID: PMC9758812 DOI: 10.1186/s41927-022-00305-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Assessing medication adherence in rheumatoid arthritis (RA) is clinically significant as low adherence is associated with high disease activity. Self-reported medication adherence surveys have been shown to have problems with overestimation of adherence due to social desirability bias. However, no MTX adherence studies adjusted for social desirability have been conducted to date. This study aimed to evaluate adherence to MTX and perform an investigatory search for factors associated with MTX adherence including social desirability. METHODS This cross-sectional multicenter study was conducted among adult RA patients consuming oral MTX for ≥ 3 months. We examined the distribution of MTX adherence, according to the eight-item Morisky Medication Adherence Scale (MMAS-8). Social desirability was using the Social Desirability Scale (SDS). Furthermore, an exploratory factor analysis involving social desirability was examined to identify factors associated with MTX adherence using linear regression analysis. To deal with missing values, we used multiple imputations with chained equations methods. RESULTS A total of 165 RA patients were enrolled. The median age was 64 years, and 86.1% were women. Based on the MMAS-8, low, medium, and high adherences were noted in 12.1%, 60.0%, and 27.9% of participants, respectively. High social desirability (coefficient, 0.14; 95% confidence interval [CI], 0.05-0.23; p < 0.05) and high age (coefficient per 10 years, 0.16; 95% CI, 0.01-0.03; p < 0.05) were associated with high MTX adherence, whereas full-time work was negatively associated with high MTX adherence (coefficient, -0.50; 95% CI, -0.95--0.05; p < 0.05). CONCLUSIONS A large proportion of patients with RA do not take MTX as prescribed. High social desirability, high educational level, and non-full-time work may be associated with high MTX adherence. Physicians should confirm MTX adherence before switching or adding disease-modifying anti-rheumatic drugs in cases of uncontrolled disease activity.
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Affiliation(s)
- Nobuyuki Yajima
- grid.410714.70000 0000 8864 3422Division of Rheumatology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan ,grid.258799.80000 0004 0372 2033Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan ,grid.411582.b0000 0001 1017 9540Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
| | - Takashi Kawaguchi
- grid.410785.f0000 0001 0659 6325Department of Practical Pharmacy, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Ryo Takahashi
- grid.410714.70000 0000 8864 3422Division of Rheumatology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
| | - Hiroki Nishiwaki
- grid.412808.70000 0004 1764 9041Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan ,grid.410714.70000 0000 8864 3422Showa University Research Administration Center, Tokyo, Japan
| | - Yoichi Toyoshima
- grid.412812.c0000 0004 0443 9643Department of Orthopedic Surgery, Showa University Toyosu Hospital, Tokyo, Japan
| | - Koei Oh
- grid.482675.a0000 0004 1768 957XDepartment of Orthopedic Surgery, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Tsuyoshi Odai
- grid.482675.a0000 0004 1768 957XDepartment of Internal Medicine, Showa University Northern Yokohama Hospital, Yokohama, Japan ,Department of Rheumatology, Yokohama Asahi Central General Hospital, Kanagawa, Japan
| | - Takayuki Kanai
- Department of Nephrology, Kanto Rosai Hospital, Kawasaki, Japan
| | - Donald E. Morisky
- grid.19006.3e0000 0000 9632 6718Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, USA
| | - Takuhiro Yamaguchi
- grid.69566.3a0000 0001 2248 6943Division of Biostatistics, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Tsuyoshi Kasama
- grid.410714.70000 0000 8864 3422Division of Rheumatology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan
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Usage and Adherence of Seven Advanced Therapies with Differing Mechanisms of Action for Inflammatory Arthritis in Canada. Rheumatol Ther 2022; 9:1399-1420. [PMID: 36045308 PMCID: PMC9510085 DOI: 10.1007/s40744-022-00485-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/14/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction This retrospective, observational study aimed to analyze and assess adherence, persistence, dosing, and use of concomitant medications of seven self-administered target drugs (abatacept, golimumab, secukinumab, tocilizumab, ustekinumab, apremilast, and tofacitinib) that are currently available in Canada for the treatment of inflammatory arthritis (IA). Methods We used IQVIA’s longitudinal claims databases, which include private drug plans and public plans. Patients with IA identified using a proprietary indication algorithm who initiated treatment with any of the target drugs between January 2015 and February 2019 were selected and followed for 12 months. Results Golimumab and apremilast had the highest proportion of patients (~ 75%) who were bio-naïve and secukinumab had the fewest bio-naïve patients (~ 43%). The oral therapies, apremilast and tofacitinib, had the lowest percentage of adherent patients (73% and 71%) followed by abatacept (83%), while the remaining drugs had adherence around 90%. Secukinumab and tofacitinib had the highest 12-month persistence rate (63% and 61%), while abatacept and apremilast had the lowest persistence rate (52% and 47%). Oral corticosteroid (OCS) use was not significantly associated with adherence. Tocilizumab, secukinumab, and ustekinumab had the highest proportion of patients (> 20%) with dose escalation at 3–4 months from index. OCS and conventional disease-modifying antirheumatic drugs (cDMARD) use decreased in post-index period across all target drugs. Conclusion This study identified substantial differences in patient baseline characteristics. Patients on injectable biologics were more likely to be adherent compared with those on oral drugs, possibly owing to longer dosing intervals. Other outcomes at 12 months appeared similar as evidenced by tapering of concomitant medications, although differences in persistence and dose escalation were noted.
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Schröder D, Heinemann S, Heesen G, Klawonn F, Mikuteit M, Niewolik J, Steffens S, Behrens G, Jablonka A, Müller F. Who is pausing immunosuppressive medication for COVID-19 vaccination? Results of an exploratory observational trial. Eur J Med Res 2022; 27:97. [PMID: 35733228 PMCID: PMC9214675 DOI: 10.1186/s40001-022-00727-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The influence of immunosuppressive therapy on immunogenicity after COVID-19 vaccination remains unclear. This study surveys patients who receive immunosuppressive therapy about whether or not they paused their immunosuppressive medication while receiving SARS-CoV-2 vaccination. METHODS In this prospective observational study, immunosuppressed participants were asked by phone and email about their medication before and during vaccination and who-if anyone-advised them to pause their medication. In addition, a baseline paper-based questionnaire contributes general characteristics regarding age, gender, immunosuppressive medication(s) and the chronic disease(s) requiring immunosuppressive therapy. RESULTS Of 207 surveyed participants, 59 persons (28.5%) paused their immunosuppressive medication before/during vaccination. Persons with rheumatic conditions and women were significantly more likely to pause immunosuppressive therapy than others. Over half of those who paused their medication reported receiving a recommendation from their specialist and 22.0% (13 of 59) decided to pause medication themselves without consulting a physician in advance. CONCLUSIONS Besides lack of evidence, many immunosuppressed individuals and their treating physicians choose to pause medication before COVID-19 vaccination and accepting the risk of worsening their underlying disease. TRIAL REGISTRATION DRKS00023972, registered 12/30/2020.
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Affiliation(s)
- Dominik Schröder
- Department of General Practice, University Medical Center Goettingen, Goettingen, Germany
| | - Stephanie Heinemann
- Department of General Practice, University Medical Center Goettingen, Goettingen, Germany
| | - Gloria Heesen
- Department of General Practice, University Medical Center Goettingen, Goettingen, Germany
| | - Frank Klawonn
- Department of Computer Science, Ostfalia University of Applied Sciences, Wolfenbuettel, Germany.,Biostatistics Group, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Marie Mikuteit
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Jacqueline Niewolik
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Sandra Steffens
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Georg Behrens
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Alexandra Jablonka
- German Center for Infection Research (DZIF), Partner Site Hannover, Braunschweig, Germany.,Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Frank Müller
- Department of General Practice, University Medical Center Goettingen, Goettingen, Germany.
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Cohen SB, Haraoui B, Curtis JR, Smith TW, Woolcott J, Gruben D, Murray CW. Impact of Methotrexate Discontinuation, Interruption, or Persistence in US Patients with Rheumatoid Arthritis Initiating Tofacitinib + Oral Methotrexate Combination. Clin Ther 2022; 44:982-997.e2. [PMID: 35667900 DOI: 10.1016/j.clinthera.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/22/2022] [Accepted: 05/04/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Using data from real-world practice, this analysis compared outcomes in patients with rheumatoid arthritis (RA) initiating treatment with an oral Janus kinase inhibitor, tofacitinib, in combination with persistent, discontinued, or interrupted treatment with oral methotrexate (MTX). METHODS This retrospective claims analysis (MarketScan® databases) included data from US patients with RA and at least one prescription claim for tofacitinib, dated between January 1, 2013, and April 30, 2017. Eligible patients were continuously enrolled for ≥12 months before and after treatment initiation, and initiated tofacitinib in combination with oral MTX, with at least two prescription claims for each. Patients were grouped according to treatment pattern (MTX-Persistent, MTX-Discontinued, or MTX-Interrupted). Tofacitinib treatment persistence, adherence, and effectiveness, as well as all-cause and RA-related health care costs, were assessed. FINDINGS A total of 671 patients were eligible for inclusion; 504 (75.1%) were MTX-Persistent; 131 (19.5%), MTX-Discontinued; and 36 (5.4%), MTX-Interrupted. Rates of tofacitinib treatment persistence, adherence, and effectiveness at 12 months were similar between the MTX-Persistent and MTX-Discontinued cohorts. The percentage of patients switched from tofacitinib to another advanced disease-modifying antirheumatic drug within 12 months of tofacitinib initiation was greater in the MTX-Persistent cohort compared with that in the MTX-Discontinued cohort. RA-related health care costs at 12 months post-initiation were significantly greater in the MTX-Persistent cohort compared with those in the MTX-Discontinued cohort. IMPLICATIONS The findings from this analysis of real-world data indicate that patients who initiate tofacitinib in combination with oral MTX may discontinue MTX and still experience outcomes similar to those in patients who persist with MTX, with lesser RA-related health care costs. These results support those from a previous clinical study on methotrexate withdrawal in patients with RA (NCT02831855).
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Affiliation(s)
- Stanley B Cohen
- Metroplex Clinical Research Center and University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Boulos Haraoui
- Institut de Rhumatologie de Montréal, Montreal, Quebec, Canada
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Hebing RC, Aksu I, Twisk JW, Bos W, Van den Bemt B, Nurmohamed MT. Effectiveness of electronic drug monitoring feedback to increase adherence in patients with RA initiating a biological DMARD: a randomised clinical trial. RMD Open 2022; 8:rmdopen-2021-001712. [PMID: 35121638 PMCID: PMC8819786 DOI: 10.1136/rmdopen-2021-001712] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/14/2021] [Indexed: 11/30/2022] Open
Abstract
Objective Medication non-adherence in rheumatoid arthritis (RA) is associated with disease flares, increased disability and increased costs. This study assessed the effectiveness of electronic monitoring feedback (EMF) on medication adherence in patients with RA starting with or switching to a new biological disease-modifying antirheumatic drug (bDMARD). Methods In this randomised controlled trial, bDMARD starters were assigned to the intervention or control group and followed for 1 year. The intervention group received a needle container with a Medication Event Monitoring System (MEMS) cap registering patient’s adherence to injections. Scores were calculated every 3 months with MEMS and motivational interviewing feedback was given. The control group received usual care. Effectiveness of EMF on adherence was measured with the medication possession ratio (MPR). Results 104 consecutive intervention patients were included and 102 controls. MPR was 0.95 (SD: 0.10) and 0.90 (0.16) after 12 months (B: 0.036, 95% CI: 0.001 to 0.007, p=0.045). bDMARD-naive patients receiving EMF achieved low disease activity (LDA) sooner compared with the control group, adjusted for baseline DAS (HR: 1.68, 95% CI: 1.00 to 2.81, p=0.050). Side effects and DAS28 were similar. Conclusion EMF increased adherence for patients with RA starting with or switching to a bDMARD. Especially bDMARD-naive patients achieved LDA sooner compared with the control group, which holds promise for the future.
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Affiliation(s)
- Renske Cf Hebing
- Rheumatology, Pharmacy, Reade Hoofdlocatie Dr Jan van Breemenstraat, Amsterdam, The Netherlands
| | - Iremnur Aksu
- Reade Hoofdlocatie Dr Jan van Breemenstraat, Amsterdam, The Netherlands
| | - Jos Wr Twisk
- Department of Methodology and Applied Biostatistics, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Wouter Bos
- Rheumatology, Reade Hoofdlocatie Dr Jan van Breemenstraat, Amsterdam, The Netherlands
| | - Bart Van den Bemt
- Pharmacy, Sint Maartenskliniek Afdeling Reumatologie, Nijmegen, The Netherlands
| | - Michael T Nurmohamed
- Rheumatology and Internal Medicine, Reade Hoofdlocatie Dr Jan van Breemenstraat, Amsterdam, The Netherlands
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Giollo A, Fuzzi E, Doria A. Methotrexate in early rheumatoid arthritis: Is the anchor drug still holding? Autoimmun Rev 2022; 21:103031. [PMID: 34995761 DOI: 10.1016/j.autrev.2022.103031] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/02/2022] [Indexed: 12/29/2022]
Abstract
Treat-to-target (T2T) is currently the most fashionable strategy for treatment-naïve, early rheumatoid arthritis (RA) patients. A T2T approach can lead to a complete and drug-free disease remission, whereas failure to obtain remission leads to damage early in the disease course. Hence, one should try to achieve high remission rates as early as possible, implementing the best therapeutic strategies available. Methotrexate (MTX) combined with glucocorticoid bridging is the mainstay of T2T. However, MTX is often used suboptimally in RA patients for many reasons, including poor tolerability, low compliance, and safety issues. Recent evidence has suggested that novel targeted synthetic DMARDs (tsDMARDs) such as the Janus-kinase (JAK) inhibitors in combination with glucocorticoids yielded better outcomes in early RA than conventional treatment. Such an approach may have advantages in terms of patients' outcomes, though some concerns about serious adverse events need to be addressed.
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Affiliation(s)
- Alessandro Giollo
- Division of Rheumatology, Department of Medicine, University of Padova Hospital Trust, Padova, Italy.
| | - Enrico Fuzzi
- Division of Rheumatology, Department of Medicine, University of Padova Hospital Trust, Padova, Italy
| | - Andrea Doria
- Division of Rheumatology, Department of Medicine, University of Padova Hospital Trust, Padova, Italy.
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Panichaporn S, Chanapai W, Srisomnuek A, Thaweeratthakul P, Katchamart W. Validity and Reliability of the Thai Version of the 19-Item Compliance-Questionnaire-Rheumatology. Patient Prefer Adherence 2022; 16:2149-2158. [PMID: 36003800 PMCID: PMC9393110 DOI: 10.2147/ppa.s374445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/11/2022] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To evaluate the psychometric properties and feasibility of the Thai version of Compliance-Questionnaire-Rheumatology (CQR)-19. PATIENTS AND METHODS A cross-sectional study was conducted in the Rheumatology clinic of Siriraj hospital from October 2020 to March 2022. Literate patients diagnosed with rheumatoid arthritis and aged ≥ 18 years old were included. Participants completed the Thai CQR-19 at baseline and during a follow-up visit. A pill count at the follow-up visit indicating that ≤ 80% of prescribed pills were taken was defined as poor compliance. Feasibility was assessed by the time to completion and the number of missing questions. RESULTS 156 participants were enrolled and 88% were in good compliance. The sensitivity of the CQR-19 to detect good compliance was 78.2% and the specificity was 27.8%. The Thai CQR-19 showed moderate agreement (Gwet's AC1= 0.61, p < 0.01) with 72.2% agreement against pill counts. The Thai CQR-19 had good internal consistency (Cronbach's alpha = 0.83) with moderate test-retest reliability (intraclass coefficients = 0.64, 95% CI 0.54-0.73; p < 0.05). There was a weak correlation between the Thai CQR-19 and disease activity (rs = 0.20, p < 0.05), and no correlation with functional disability (rs = 0.09, p = 0.25). The median (IQR) completion time was 4.42 (3.25-6.16) minutes and 114 (73%) completed all 19 questions. CONCLUSION The Thai version of CQR-19 is a valid and reliable tool to assess medication compliance in Thai patients with RA. To ensure completeness and accuracy, this questionnaire may be administered by interview.
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Affiliation(s)
- Saranya Panichaporn
- Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanwisa Chanapai
- Division of Clinical Trials, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ananya Srisomnuek
- Division of Clinical Trials, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phakhamon Thaweeratthakul
- Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanruchada Katchamart
- Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Correspondence: Wanruchada Katchamart, Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand, Tel +66 2 419 7775, Fax +66 2 418 3222, Email
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25
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Omair MA, Alshehri MM, Altokhais NA, Aljanobi GA, El Dessougi MI, AlHarthi A, Omair MA, Attar SM, Bahlas SM, Alfurayj AS, Alazmi MS, Asiri AM, AlOmair MM, Al Juffali L, Almalag HM. Exploring Factors Influencing Medication Compliance in Saudi Rheumatoid Arthritis Patients: A Nationwide Cross-Sectional Survey - Results from the COPARA Study. Patient Prefer Adherence 2022; 16:1105-1114. [PMID: 35502428 PMCID: PMC9056069 DOI: 10.2147/ppa.s363477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Compliance is essential to achieve treatment goals in rheumatoid arthritis (RA) patients. The current study evaluated compliance and related factors in a large and diverse population. PATIENTS AND METHODS Patients with RA who received active treatment were invited to participate in an online survey. The Arabic versions of the 5-Item Compliance Questionnaire for Rheumatology (ACQR-5) and the RA Impact of Disease (RAID) were used to measure compliance and disability, respectively. The patients were sub-grouped based on background disease-modifying anti-rheumatic drugs (DMARDs). Variables associated with high compliance were selected for the logistic regression analysis. RESULTS A total of 1241 patients completed the survey and were included in the final analysis. Of those, 1055 (85%) were females with a mean (±SD) age and disease duration of 47.14 ± 13.71 and 8.77 ± 7.43 years, respectively. The mean RAID was 4.4±2.58, with 980 (79%) having an unacceptable level state. Patients with an unacceptable RAID level had a lower compliance rate (78.8% vs 85.8%, p = 0.001). Demographics associated with high compliance were female sex and increased age, with reported odds ratios of 1.018 (95% CI: 1.007-1.028) and 1.464 (95% CI: 1.016-2.108), respectively. Compliance was similar between patients on Janus kinase inhibitors or biological DMARDs (88.14% vs 80.83%, p = 0.17), between monotherapy, double therapy, or triple therapy recipients (80% vs 82.23% vs 81.32%, p = 0.665), and between patients receiving injectable and oral therapy (77.32% vs 81.14%, p = 0.246). CONCLUSION A high compliance level was observed in this population, with patient demographics influencing compliance rather than the medication type or route of administration. Interventional studies should focus on the of high-risk patients identified in this study.
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Affiliation(s)
- Mohammed A Omair
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
- Correspondence: Mohammed A Omair, Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia, Tel +966505270513, Email
| | - Maha M Alshehri
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | | | - Ghada A Aljanobi
- Rheumatology Unit, Department of Medicine, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Maha I El Dessougi
- Rheumatology Unit, Department of Medicine, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Amal AlHarthi
- Rheumatology Unit, Department of Medicine, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Maha A Omair
- Department of Statistics and Operations Research, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Suzan M Attar
- Rheumatology Unit, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sami M Bahlas
- Rheumatology Unit, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdullah S Alfurayj
- Rheumatology Unit, Department of Medicine, Buraidah Central Hospital, Buraidah, Saudi Arabia
| | - Mansour S Alazmi
- Rheumatology Unit, Department of Medicine, Prince Mohammed Medical City, Sakaka-Aljouf, Saudi Arabia
| | - Alhussain M Asiri
- Rheumatology Unit, Department of Medicine, Aseer Central Hospital, Abha, Saudi Arabia
| | - Mohammed M AlOmair
- Rheumatology Unit, Department of Medicine, Aseer Central Hospital, Abha, Saudi Arabia
| | - Lobna Al Juffali
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Haya M Almalag
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Patient-Reported Nausea and Fatigue Related to Methotrexate: A Prospective, Self-Controlled Study in the ArthritisPower ® Registry. Rheumatol Ther 2021; 9:207-221. [PMID: 34843092 PMCID: PMC8628141 DOI: 10.1007/s40744-021-00398-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/03/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction The magnitude and frequency of temporally related methotrexate (MTX)-associated side effects in rheumatoid arthritis (RA) or psoriatic arthritis (PsA) patients are difficult to quantify using traditional research methods. As proof of concept designed in part to implement digital data collection for remote patient monitoring, we conducted a study implementing self-controlled case series analytic methods to understand MTX-related symptoms in RA or PsA. Methods In study phase 1, adults with RA or PsA from the ArthritisPower® Registry (past or current oral MTX users) participated in a cross-sectional survey. In phase 2, current MTX users participated in a longitudinal study and completed the Patient-Reported Outcomes Measurement Information System (PROMIS®) 1-day nausea/vomiting and fatigue measure. Within-person change in PROMIS scores between risk (6–36 h post-dose) and control (96–144 h post-dose) windows were compared using mixed models. Results The baseline survey was completed by 671 participants (mean age: 54 years, 88% female, 92% white, 79% with RA). Among current MTX users (353/671 [53%]), most reported MTX-associated side effects (216/353 [61%]), most frequently fatigue (161/353 [46%]). Among phase 2 participants with (n = 39) and without (n = 84) baseline nausea, mean increase in PROMIS nausea was 5.1 units (P < 0.0001) and 0.7 units (P = 0.135), respectively; among those with (n = 51) and without (n = 72) baseline fatigue, mean increase in PROMIS fatigue was 3.9 units (P = 0.0003) and 0.4 units (P = 0.554), respectively. Conclusions Digital remote patient monitoring presents an opportunity to detect and address medication tolerability in real time. Using a novel study design to control for between-person confounding, the magnitude of nausea and fatigue experienced by participants with RA and PsA temporally related to weekly MTX use was substantial. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00398-6.
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Abdel Salam L, Aldarwesh AQ, Eleishi HH. Whole exome sequencing (WES) of methotrexate response/adverse event profile in rheumatoid arthritis patients. THE EGYPTIAN RHEUMATOLOGIST 2021. [DOI: 10.1016/j.ejr.2020.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2023]
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Burmester GR, Bykerk VP, Buch MH, Tanaka Y, Kameda H, Praestgaard A, van Hoogstraten H, Fernandez-Nebro A, Huizinga T. Sarilumab monotherapy versus sarilumab and methotrexate combination therapy in patients with rheumatoid arthritis. Rheumatology (Oxford) 2021; 61:2596-2602. [PMID: 34508594 PMCID: PMC9157062 DOI: 10.1093/rheumatology/keab676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/23/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Sarilumab, as monotherapy or in combination with conventional synthetic DMARDs, such as methotrexate (MTX), has demonstrated improvement in clinical outcomes in patients with RA. The primary objective of this post hoc analysis was to compare the efficacy of sarilumab (200 mg every 2 weeks) monotherapy (MONARCH study) with that of sarilumab and MTX combination therapy (MOBILITY study) at week 24. METHODS The endpoints assessed were mean change from baseline in the Clinical Disease Activity Index (CDAI), 28-joint Disease Activity using C-Reactive Protein (DAS28-CRP), CRP, haemoglobin (Hb), pain visual analogue scale (VAS) and Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue. Least square (LS) mean change from baseline (95% confidence interval [CI]) at week 24 for all endpoints was compared between the treatment arms for adjusted comparisons. RESULTS This analysis included 184 patients on sarilumab monotherapy and 399 patients on sarilumab plus MTX. Differences (p < 0.05) were observed in ethnicity, region, body mass index group, rheumatoid factor, anti-cyclic citrullinated peptide antibodies, swollen joint count, CRP, CDAI and oral glucocorticoid use between these treatment groups. After adjusting for these differences in a mixed-effect model repeated measure, LS mean change from baseline for all assessments was similar between the treatment groups with overlapping CIs: CDAI, -28.79 vs -26.21; DAS28-CRP, -2.95 vs -2.81; CRP, -18.31 vs -16.46; Hb, 6.59 vs 8.09; Pain VAS, -33.62 vs -31.66; FACIT-Fatigue, 9.90 vs 10.24. CONCLUSION This analysis demonstrated that the efficacy of sarilumab monotherapy was similar to that of sarilumab and MTX combination therapy.
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Affiliation(s)
- Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - University Medicine Berlin, Berlin, Germany
| | - Vivian P Bykerk
- Inflammatory Arthritis Center, Hospital for Special Surgery, New York, NY, USA
| | - Maya H Buch
- Centre for Musculoskeletal Research, Division of Musculoskeletal & Dermatological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Hideto Kameda
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | | | | | - Antonio Fernandez-Nebro
- UGC Rheumatology, Institute of Biomedical Research in Malaga (IBIMA), Regional University Hospital of Malaga, University of Málaga, Málaga, Spain
| | - Thomas Huizinga
- Department of Rheumatology, Leiden University, Leiden, the Netherlands
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Vijaykumar D, Dhir V, Jain S, Pai V, Kaur J, Naidu GS, Sharma A, Khanna Sharma S, Jain S. Assessing methotrexate intolerance and its prevalence in rheumatoid arthritis: Development and validation of the MISA questionnaire. Int J Rheum Dis 2021; 24:1294-1301. [PMID: 34432365 DOI: 10.1111/1756-185x.14207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/29/2021] [Accepted: 08/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Methotrexate (MTX) intolerance refers to unpleasant symptoms that accompany use of MTX. Although a validated questionnaire on MTX intolerance exists for children with juvenile idiopathic arthritis, it is lacking for adult rheumatoid arthritis (RA) patients. METHODS A 10-item questionnaire called Methotrexate Intolerance and Severity assessment in Adults (MISA) was developed to assess MTX intolerance. On receiver operating characteristic analysis, its predictive ability was compared to Methotrexate Intolerance Severity Score (MISS), a validated questionnaire for children. Subsequently, prevalence and associations of intolerance were assessed in 414 RA patients. After 1 year, discontinuation of MTX was compared between patients with and without MTX intolerance. RESULTS MISA score had a good predictive ability (area under the curve [AUC] of 0.904), with sensitivity and specificity of 91.4% and 84.3% (cut-off ≥1) to correctly classify MTX intolerance and was better than MISS score (AUC of 0.823). Among 414 RA patients, 159 (38.4%) had MTX intolerance, with common symptoms being nausea, lethargy, irritability and loss of appetite. On multivariable analysis, age (odds ratio 0.972) and body mass index (odds ratio 1.061) were significant predictors of MTX intolerance. At 1 year, a higher proportion of patients with intolerance than without intolerance had discontinued MTX (odds ratio 2.4, P = 0.02). To classify severity of intolerance, another score, MISA-cross-product, was developed and validated, with an AUC of 0.899. CONCLUSIONS The newly developed MISA questionnaire and score had good predictive ability to diagnose MTX intolerance. Intolerance to MTX was common, being found in one-third of RA patients. Patients with intolerance were twice more likely to discontinue MTX at 1 year.
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Affiliation(s)
- Deeksha Vijaykumar
- Department of Internal Medicine (Rheumatology Division), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Varun Dhir
- Department of Internal Medicine (Rheumatology Division), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Siddharth Jain
- Department of Internal Medicine (Rheumatology Division), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Venkatesh Pai
- Division of Rheumatology, Department of General Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Jaswinder Kaur
- Department of Internal Medicine (Rheumatology Division), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Godasi Srsnk Naidu
- Department of Internal Medicine (Rheumatology Division), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine (Rheumatology Division), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shefali Khanna Sharma
- Department of Internal Medicine (Rheumatology Division), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sanjay Jain
- Department of Internal Medicine (Rheumatology Division), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Strand V, Tundia N, Wells A, Buch MH, Radominski SC, Camp HS, Friedman A, Suboticki JL, Dunlap K, Goldschmidt D, Bergman M. Upadacitinib monotherapy improves patient-reported outcomes in rheumatoid arthritis: results from SELECT-EARLY and SELECT-MONOTHERAPY. Rheumatology (Oxford) 2021; 60:3209-3221. [PMID: 33313898 PMCID: PMC8516509 DOI: 10.1093/rheumatology/keaa770] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/12/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To evaluate the effect of upadacitinib (UPA) monotherapy vs MTX on patient-reported outcomes (PROs) in patients with RA who were MTX-naïve or who had an inadequate response to MTX (MTX-IR). METHODS PROs from the SELECT-EARLY and SELECT-MONOTHERAPY randomized controlled trials were evaluated at Weeks 2 and 12/14. Patients were ≥18 years of age with RA symptoms for ≥6 weeks (SELECT-EARLY, MTX-naïve) or diagnosed RA for ≥3 months (SELECT-MONOTHERAPY, MTX-IR) and received UPA monotherapy (15 or 30 mg) or MTX. PROs included Patient Global Assessment of Disease Activity (PtGA), pain visual analogue scale, HAQ Disability Index (HAQ-DI), morning stiffness duration/severity, Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue (SELECT-EARLY), health-related quality of life (HRQOL) by the 36-iem Short Form Health Survey and Work Productivity and Activity Impairment (WPAI; SELECT-EARLY). Least square mean (LSM) changes and proportions of patients reporting improvements greater than or equal to the minimum clinically important differences and normative values were determined. RESULTS In 945 MTX-naïve and 648 MTX-IR patients, UPA monotherapy (15 mg, 30 mg) vs MTX resulted in greater reported LSM changes from baseline at Weeks 12/14 in PtGA, pain, HAQ-DI, morning stiffness duration/severity, FACIT-F (SELECT-EARLY), HRQOL and WPAI (SELECT-EARLY). These changes were statistically significant with both doses of UPA vs MTX at Weeks 12/14 in both RCTs. Improvements were reported as early as week 2. Compared with MTX, more UPA-treated MTX-naïve and MTX-IR patients reported improvements greater than or equal to the minimum clinically important differences and scores greater than or equal to normative values. CONCLUSION Among MTX-naïve and MTX-IR patients with active RA, UPA monotherapy at 15 or 30 mg for 12/14 weeks resulted in statistically significant and clinically meaningful improvements in pain, physical function, morning stiffness, HRQOL and WPAI compared with MTX alone. CLINICAL TRIAL REGISTRATION NUMBER SELECT-EARLY (NCT02706873) and SELECT-MONOTHERAPY (NCT02706951) are registered with ClinicalTrials.gov.
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Affiliation(s)
- Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Namita Tundia
- HEOR Immunology, AbbVie Inc., North Chicago, IL, USA
| | - Alvin Wells
- Aurora Rheumatology and Immunotherapy Center, Franklin, WI, USA
| | - Maya H Buch
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University Foundation Trust, Manchester, UK
| | | | - Heidi S Camp
- Clinical Immunology, AbbVie Inc., North Chicago, IL, USA
| | - Alan Friedman
- Clinical Immunology, AbbVie Inc., North Chicago, IL, USA
| | | | | | | | - Martin Bergman
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
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Generali E, Carrara G, Bortoluzzi A, De Santis M, Ceribelli A, Scirè CA, Selmi C. Non-adherence and discontinuation rate for oral and parenteral methotrexate: A retrospective-cohort study in 8,952 patients with psoriatic arthritis. J Transl Autoimmun 2021; 4:100113. [PMID: 35005587 PMCID: PMC8716656 DOI: 10.1016/j.jtauto.2021.100113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIMS Treatment options for PsA, following non-steroidal anti-inflammatory drugs (NSAIDs), include conventional synthetic disease modifying anti-rheumatic drugs (csDMARDS), particularly methotrexate (MTX). The present study was performed to determine the non-adherence and discontinuation rates of different methotrexate (MTX) formulations in psoriatic arthritis (PsA). APPROACH AND RESULTS We performed a retrospective-cohort study on patients with PsA identified by disease-specific code in the administrative-health-databases of a Northern Italian region (Lombardy) between 2004 and 2015. Subjects were defined as non-adherent if less than 80% of the prescribed MTX dose was taken based on the time between each prescription. Discontinuation rates were calculated using the time between the first and the last MTX prescription over an observation period of 120 months. Among 8952 patients with PsA, 33% were treated with MTX (mean dosage 10 mg/week ± 2.5 mg standard deviation), more frequently (59%) in its parenteral formulation at a 10 mg weekly dosage (35%). Oral glucocorticoids were prescribed to 21% of patients, while non-steroidal anti-inflammatory drugs to 45%. Approximately 37% of patients with PsA were defined as non-adherent to MTX, with the oral formulation associated with an increased risk of non-adherence (hazard ratio 2.08, 95% confidence interval 1.84-2.35, p < 0.001) compared with parenteral 10-15 mg weekly doses. Oral MTX was discontinued in 52% of cases without a significantly increased risk of discontinuation compared to parenteral formulations which, at higher dosages, had a more favorable retention rate. CONCLUSION Oral MTX formulation is associated with a 2-fold risk of non-adherence compared to MTX parenteral route in PsA.
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Key Words
- Adherence
- HCQ, hydroxychloroquine
- HR, Hazard ratio
- IQR, inter-quartile range
- LEF, leflunomide
- MTX, methotrexate
- Methotrexate
- NSAIDs, non-steroidal anti-inflammatory drugs
- OGC, oral glucocorticoids
- Oral
- Parenteral
- PsA, psoriatic arthritis
- PsO, psoriasis
- Psoriatic arthritis
- Retention rate
- SSZ, sulfasalazine
- TNF, tumor necrosis factor alpha
- list: csDMARDs, conventional synthetic disease modifying anti-rheumatic drugs
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Affiliation(s)
- Elena Generali
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital - IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Greta Carrara
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | | | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital - IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Angela Ceribelli
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital - IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Carlo A. Scirè
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
- University of Ferrara, Ferrara, Italy
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital - IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Curtis JR, Nebesky JM, de Bock E, de la Loge C, Arnould B, Davey R, Devenport J, Pethö-Schramm A. Development and validation of the Methotrexate Experience Questionnaire, a new methotrexate oral treatment adherence tool in rheumatoid arthritis. J Patient Rep Outcomes 2021; 5:69. [PMID: 34373947 PMCID: PMC8353039 DOI: 10.1186/s41687-021-00339-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/06/2021] [Indexed: 02/07/2023] Open
Abstract
Objective Despite the development of new biologic therapies, methotrexate (MTX) remains the preferred initial disease-modifying anti-rheumatic drug to treat rheumatoid arthritis (RA). Adherence to disease-modifying anti-rheumatic drugs is suspected to be highly variable potentially leading to reduced treatment effectiveness. This work aimed to develop and validate the Methotrexate Experience Questionnaire (MEQ), a tool to identify and characterize non-adherence to oral MTX. Methods MEQ development included a literature review and qualitative interviews with RA patients and physicians in the United States. A retrospective, cross-sectional study using data from Optimum Patient Care Research Database, a large primary care database of electronic medical records in the United Kingdom, was conducted to finalize the MEQ and evaluate its psychometric properties. Results Three hundred seven e-consented subjects (66% women, mean age of 65 years) completed the MEQ remotely, and were included in this analysis. Item-convergent and divergent validity were generally supportive of the construct validity of the MEQ and Cronbach’s alpha of 0.87 supported its reliability. The MEQ Total score presented statistically significant correlations of small to medium size with all selected concurrent scales, as expected; the highest correlation was obtained between the general acceptance score of ACCEPT and the MEQ Total score (0.55, p < 0.001). Known-groups validity was demonstrated as a logical pattern of higher MEQ scores was obtained for patients considered adherent with both the 6- and 12-month Proportion of Days Covered (mean MEQ total score 82.7 for 12-month PDC ≥ 80% against 76.3 for 12-month PDC < 80%, p< 0.0001). Additionally, a pattern of lower MEQ scores was obtained for patients with more severe disease assessed with Routine Assessment of Patient Index Data 3. Conclusion The 24-item MEQ is a reliable and valid instrument to assess the adherence of RA patients taking MTX, potentially improving over historical refill rate metrics by providing insights into the individual reasons for lack of adherence. This information should facilitate clinician-patient discussions and help inform treatment decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00339-5.
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Affiliation(s)
- Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, FOT 802, 510 20th Street South, Birmingham, AL, 35294, USA.
| | | | | | | | | | | | - Jenny Devenport
- Pharmaceuticals Division, F. Hoffmann-La Roche, Basel, Switzerland
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Hitchon CA, Mody GM, Feldman CH, Lau Y, Shi S, Meltzer M, Scuccimarri R, Weinblatt ME, Colmegna I. Perceptions and Challenges Experienced by African Physicians When Prescribing Methotrexate for Rheumatic Disease: An Exploratory Study. ACR Open Rheumatol 2021; 3:522-530. [PMID: 34196510 PMCID: PMC8363848 DOI: 10.1002/acr2.11290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/13/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Guidelines for methotrexate (MTX) use in rheumatic disease may not be feasible for physicians practicing in the least developed countries. We aimed to understand the experiences of MTX prescribers relating to MTX use for rheumatic disease in African countries to inform the development of culturally and geographically appropriate recommendations. METHODS African physicians who self-identified as MTX prescribers from countries classified as having a low versus a medium or high Human Development Index (L-HDI versus MH-HDI) participated in semistructured interviews between August 2016 and September 2017. Interviews were transcribed verbatim, coded thematically, and stratified by HDI. RESULTS Physicians (23 rheumatologists; six internists) from 29 African countries were interviewed (15 L-HDI; 14 MH-HDI). Identified barriers to MTX use included inconsistent MTX supply (reported by 87% L-HDI versus 43% MH-HDI), compounded by financial restrictions (reported by 93% L-HDI versus 64% MH-HDI), patient hesitancy based partly on cultural beliefs and societal roles (reported by 71%), few prescribers (reported by 33%), prevalent infections (especially viral hepatitis, tuberculosis, and human immunodeficiency virus), and both availability and cost of monitoring tests. MTX pretreatment evaluation and starting and maximal doses were similar between L-HDI countries and MH-HDI countries. CONCLUSION The challenges of treating rheumatic disease in African countries include unreliable drug availability and cost, limited subspecialists, and patient beliefs. Adapting recommendations for MTX use in the context of prevalent endemic infections; ensuring safe but feasible MTX monitoring strategies, enhanced access to stable drug supply, and specialized rheumatology care; and improving patient education are key to reducing the burden of rheumatic diseases in L-HDI countries.
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Affiliation(s)
| | | | | | - Yan Lau
- McGill UniversityMontrealQuebecCanada
| | - Steven Shi
- Université de MontréalMontrealQuebecCanada
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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.
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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
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Tornero Molina J, López Robledillo JC, Casamira Ruiz N. Potential Benefits of the Self-Administration of Subcutaneous Methotrexate with Autoinjector Devices for Patients: A Review. DRUG HEALTHCARE AND PATIENT SAFETY 2021; 13:81-94. [PMID: 33824602 PMCID: PMC8018568 DOI: 10.2147/dhps.s290771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
The role of patient adherence in improving the efficacy of any treatment is widely accepted, as well as its impact in optimizing the use of healthcare resources and associated costs. Adherence is particularly affected in chronic conditions, such as rheumatoid arthritis (RA), requiring long-term therapies and a commitment of the patient to manage his/her disease. Methotrexate (MTX) is one of the mainstays of treatment for several immune-mediated inflammatory joint and skin diseases, especially RA. The use of parenteral MTX, particularly when administered as a subcutaneous (SC) injection, has recently raised a great interest to overcome the limitations of oral MTX. For addressing this issue, new optimized self-injection systems have been developed to improve the ease of use of SC MTX. Increasing evidence shows how patients tend to opt for autoinjectors over prefilled syringes or conventional syringes in terms of easiness of use, preference and satisfaction, regardless of whether the treatment is a biologic or MTX. Additionally, positive views and beliefs of patients about treatment may contribute to increasing expectations of effectiveness and treatment adherence. Similarly, the implementation of prefilled pens in clinical practice might be a way to facilitate and simplify the self-injection of SC MTX delivery, optimizing adherence and treatment outcomes as a consequence. This article aimed to review the available literature data on the use of MTX autoinjectors and their impact on treatment adherence and patients’ perceptions.
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Nakafero G, Grainge MJ, Card T, Mallen CD, Zhang W, Doherty M, Taal MW, Aithal GP, Abhishek A. What is the incidence of methotrexate or leflunomide discontinuation related to cytopenia, liver enzyme elevation or kidney function decline? Rheumatology (Oxford) 2021; 60:5785-5794. [PMID: 33725120 PMCID: PMC8645271 DOI: 10.1093/rheumatology/keab254] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/05/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives To examine incidence of treatment changes due to abnormal blood-test results and, to explore rates of treatment changes due to liver, kidney and haematological blood-test abnormalities in autoimmune rheumatic diseases (AIRD) treated with low-dose MTX or LEF. Methods Data for people with AIRDs prescribed MTX or LEF were extracted from the Clinical Practice Research Datalink. Participants were followed-up from first prescription of MTX or LEF in primary care. Primary outcome of interest was drug discontinuation, defined as a prescription gap of ≥90 days following an abnormal (or severely abnormal) blood-test result. Dose reduction was examined between consecutive prescriptions. Incidence rates per 1000 person-years were calculated. Results 15, 670 and 2,689 participants contributing 46, 571 and 4,558 person-years follow-up were included in MTX and LEF cohorts, respectively. The incidence of MTX and LEF discontinuation with abnormal (severely abnormal) blood-test was 42.24 (6.16) and 106.53 (9.42)/1000 person-years in year 1, and 22.44 (2.84) and 31.69 (4.40)/1000 person years, respectively, thereafter. The cumulative incidence of MTX and LEF discontinuation with abnormal (severely abnormal) blood tests was 1 in 24 (1 in 169), 1 in 9 (1 in 106) at 1 year; and 1 in 45 (1 in 352), 1 in 32 (1 in 227) per-year, respectively, thereafter. Raised liver enzymes were the commonest abnormality associated with drug discontinuation. MTX and LEF dose reduction incidence were comparable in year 1, however, thereafter MTX dose was reduced more often than LEF [16.60 (95% CI 13.05, 21.13) vs 8.10 (95% CI 4.97, 13.20)/1000 person-years]. Conclusion MTX and LEF were discontinued for blood-test abnormalities after year 1 of treatment, however, discontinuations for severely abnormal results were uncommon.
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Affiliation(s)
- Georgina Nakafero
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Matthew J Grainge
- Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tim Card
- Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele
| | - Weiya Zhang
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Maarten W Taal
- Division of Medical Sciences and Graduate Entry Medicine, University on Nottingham
| | - Guruprasad P Aithal
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham.,NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Abhishek Abhishek
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK.,NIHR Nottingham BRC, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
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Brzezińska O, Kuc A, Kobiałka D, Małecki D, Makowska J. Adherence with methotrexate in polish patients-Survey research results. Int J Clin Pract 2021; 75:e13677. [PMID: 32798326 DOI: 10.1111/ijcp.13677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/12/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Methotrexate (MTX) is the first-line medicine used in most inflammatory joint diseases. It is highly effective but, it's burdened with common side effects and the result of treatment is not immediately visible. This fact significantly increases the risk of unsatisfying patients' compliance. It may lead to difficulties in achieving disease remission and unjustified escalation of treatment. PURPOSE The aim of the study was to evaluate the methotrexate treatment schemes and to assess the patients' compliance with the treatment. MATERIALS AND METHODS The study was based on an online questionnaire distributed to rheumatic patients treated with MTX. The questions about MTX therapy, treatment monitoring, patients' compliance and causing of skipping drug doses were asked. RESULTS The questionnaire was filled up by 415 patients (21 men, 394 women and average age 36 ± 12.3). In 238 cases the MTX therapy was discontinued, in 148 the decision was taken by the physician, the others discontinued treatment on their own (90 subjects). From the group of patients who stopped taking MTX, 140 returned to the previous treatment. The most common cause of stopping treatment was gastrointestinal (GI) side effects. Self-discontinuation was more often explained by unbearable side-effects (63.33% vs 44.59%; P = .005) such as GI complaints, headaches and bad mood. The doctor's decision to stop treatment was more often caused by the occurrence of liver damage and the improvement of the patient's condition. Good compliance was declared by 346 patients. Most of them (61.69%) admit to skipping MTX doses. The most common reasons for missing a dose were: infectious disease and forgetfulness. The group of patients with good adherence to therapy was significantly older with longer disease duration. CONCLUSION High adherence with prescribed MTX is associated with good treatment tolerance, while the occurrence of side effects significantly increases the risk of discontinuation, often without consulting the physician.
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Affiliation(s)
- Olga Brzezińska
- Department of Rheumatology, Medical University of Lodz, Łódź, Poland
| | - Anita Kuc
- Department of Rheumatology, Medical University of Lodz, Łódź, Poland
| | - Diana Kobiałka
- Department of Rheumatology, Medical University of Lodz, Łódź, Poland
| | - Dawid Małecki
- Department of Rheumatology, Medical University of Lodz, Łódź, Poland
| | - Joanna Makowska
- Department of Rheumatology, Medical University of Lodz, Łódź, Poland
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Voshaar MJH, Vriezekolk JE, van Dulmen AM, van den Bemt BJF, van de Laar MAFJ. Ranking facilitators and barriers of medication adherence by patients with inflammatory arthritis: a maximum difference scaling exercise. BMC Musculoskelet Disord 2021; 22:21. [PMID: 33407344 PMCID: PMC7786955 DOI: 10.1186/s12891-020-03874-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 12/14/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction Facilitators and barriers of adherence to disease-modifying anti-rheumatic drugs (DMARDs) have been identified by patients with inflammatory arthritis earlier. However, the relative importance from the patients’ perspective of these factors is unknown. Knowledge on this ranking might guide the development of interventions and may facilitate targeted communication on adherence. This study aims to examine 1) the relative importance patients attach to facilitators and barriers for DMARDs adherence, and 2) the relationship between patient characteristics and ranking of these factors. Methods One hundred twenty-eight outpatients with inflammatory arthritis; (60% female, mean age 62 years (SD = 12), median disease duration 15 years, IQR (7, 23) participated in a Maximum Difference scaling exercise and ranked 35 items based upon previously identified facilitators and barriers to medication adherence. Hierarchical Bayes estimation was used to compute mean Rescaled Probability Scores (RPS; 0–100) (i.e. relative importance score). Kendall’s coefficient of concordance was used to examine a possible association between patients’ characteristics (i.e. age, sex and educational level) and ranking of the items. Results The three most important items ranked by patients were: Reduction of symptoms formulated as “Arthritis medications help to reduce my symptoms” (RPS = 7.30, CI 7.17–7.44), maintaining independence formulated as “I can maintain my independence as much as possible” (RPS = 6.76, CI 6.54–6.97) and Shared decision making formulated as “I can decide –together with my physician- about my arthritis medications” (RPS = 6.48, CI 6.24–6.72). No associations between patient characteristics and ranking of factors were found. Conclusions Reducing symptoms, maintaining independency and shared decision making are patients’ most important factors for DMARDs adherence. This knowledge might guide the development of interventions and may facilitate communication between health professionals and their patients on medication adherence.
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Affiliation(s)
- M J H Voshaar
- Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
| | - J E Vriezekolk
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - A M van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Faculty of Health and Social Sciences, University of South- Eastern Norway, Drammen, Norway
| | - B J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Pharmacy, RadboudUMC, Nijmegen, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M A F J van de Laar
- Arthritis Centre Twente, Medisch Spectrum Twente & University of Twente, P.O box 50,000, 7500, KA, Enschede, The Netherlands
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Dantas LO, Carvalho C, Prando BC, McAlindon TE, da Silva Serrão PRM. Mobile health technologies for the management of rheumatic diseases: a systematic review of online stores in Brazil. Clin Rheumatol 2021; 40:2601-2609. [PMID: 33389312 DOI: 10.1007/s10067-020-05561-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 11/29/2020] [Accepted: 12/21/2020] [Indexed: 01/17/2023]
Abstract
Rheumatic diseases are serious conditions with a low uptake of conservative treatments. Mobile health (mHealth) applications (apps) offer potential to assist the self-management of rheumatic diseases. Our goal was to perform a systematic review of available mHealth apps for rheumatic diseases in Brazil. We focused on the most prevalent rheumatic diseases: osteoarthritis, rheumatoid arthritis, fibromyalgia, systemic lupus erythematosus, osteoporosis, and axial spondylarthritis. Google Play Store and AppStore in Brazil were queried by two independent reviewers on September 2020, and the quality of eligible mHealth apps was assessed using the Mobile App Rating Scale (MARS). Of the 3173 mHealth apps found, five were eligible for inclusion. Two for fibromyalgia and two for axial spondylarthritis offered exercise, educational content, and tools to track patient-reported symptoms; and one for osteoporosis offered educational content and tracking tools only. The included apps scored moderately on the MARS quality scale, with a mean score (SD) of 3.1 (0.7) on a 0-5 scale. Most apps scored poorly based on credibility, user interface and experience, and engagement. There is growing interest in the development of mHealth technologies to support rheumatic diseases patients. Although the majority of the included apps came from non-profit organizations, they are still of poor quality and limited functionality. This study is a call for to the development of new user-centered mHealth apps that can empower rheumatic diseases patients in Brazil, especially in the area of osteoarthritis, rheumatoid arthritis, and lupus, since no apps were found.
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Affiliation(s)
- Lucas Ogura Dantas
- Physical Therapy Department, Federal University of São Carlos, São Carlos, 13565-905, Brazil
| | - Cristiano Carvalho
- Physical Therapy Department, Federal University of São Carlos, São Carlos, 13565-905, Brazil
| | - Beatriz Cardinal Prando
- Physical Therapy Department, Federal University of São Carlos, São Carlos, 13565-905, Brazil
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Omair MA, Al Suwayeh F, Almashaan A, Alqurtas E, Bedaiwi MK, Almaghlouth I, Alkahalaf A, Almalaq HM. Cross-Cultural Validation of the 5-Item Compliance Questionnaire for Rheumatology to the Arabic Language in Patients with Rheumatoid Arthritis. Patient Prefer Adherence 2021; 15:1461-1467. [PMID: 34234419 PMCID: PMC8253897 DOI: 10.2147/ppa.s316263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE A simple measure to assess drug adherence in Saudi patients with rheumatoid arthritis (RA) is required. The aim of this study was to translate and validate the 5-Item Compliance Questionnaire for Rheumatology (CQR5) into Arabic. PATIENTS AND METHODS The questionnaire was translated and culturally adapted to Arab patients in six steps: initial translation, synthesis of the translation, back translation, expert committee review, test of the pre-final version, and development of the Arabic CQR5 (ACQR-5). The resulting version was tested for validity in patients with RA. RESULTS A total of 103 adult patients with RA were recruited from rheumatology clinics at a university hospital in Riyadh, Saudi Arabia. After extensive translation, the final tool (CQR) was piloted in 15 patients. The final validation was performed with 88 patients. Of these, 80 (90.9%) were female and 43.2% were seropositive. The mean (±SD) age and disease duration were 50 (±13) and 11.4 (±8.2) years, respectively. Cronbach's alpha reliability was 0.886, and the Kaiser-Meyer-Olkin measure of sampling adequacy for factor analysis was 0.870 (p<0.001). The mean ACQR-5 was 17.78 (2.70), with 14 (15.9%) classified as low adherents and the remaining 74 (84.1%) as high adherents. Binary logistic regression revealed that increasing age (odds ratio [OR] 1.082, 95% confidence interval [CI]: 1.025-1.142, p=0.005) and a trend toward the presence of other comorbidities (OR 3.111, 95% CI: 0.961-10.070, p=0.058) were associated with low adherence. CONCLUSION ACQR-5 is a simple and feasible tool for identifying adherence levels in patients with RA in Saudi Arabia. A high level of adherence was observed in this study. Additional studies are required to assess ACQR-5 validity and adherence levels in a larger, more diverse population.
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Affiliation(s)
- Mohammed A Omair
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
- Correspondence: Mohammed A Omair Rheumatology Division, Department of Medicine (38), College of Medicine King Saud University, PO Box 2925, Riyadh, 11461, Saudi ArabiaTel/Fax +966-1-467-1546 Email
| | - Fatima Al Suwayeh
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Alanoud Almashaan
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Eman Alqurtas
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed K Bedaiwi
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Almaghlouth
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Alkahalaf
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Haya M Almalaq
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Predictive factors of treatment persistence in rheumatoid arthritis. Joint Bone Spine 2020; 87:531-534. [DOI: 10.1016/j.jbspin.2020.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/06/2020] [Indexed: 01/23/2023]
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Abdul Razak S, Makmor Bakry M, Mohamed Said MS, Tan CE, Md Redzuan A. Development and Validation of Adherence Score for Subcutaneous Biologic Disease-Modifying Antirheumatic Drugs. Front Pharmacol 2020; 11:572260. [PMID: 33240088 PMCID: PMC7681069 DOI: 10.3389/fphar.2020.572260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/29/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The biologic disease-modifying antirheumatic drugs (bDMARDs) are currently incorporated as part of the pharmacotherapy management of inflammatory arthritis (IA). Adherence to bDMARDs is crucial to ensure treatment success in IA. However, most of the recent studies evaluated adherence level in patients using subcutaneous injections of bDMARDs utilized the indirect methods adapted from adherence assessment for oral medication. Aim: This study aimed to develop a questionnaire to assess adherence to the self-injectable subcutaneous bDMARDs. Methods: The development of the Subcutaneous bDMARDs Adherence Score (SCADS) involved evaluation of content validity. Literature reviews provide the basis for domain identification and item formation. Four experts evaluated the instrument by using a four-point ordinal scale with a rubric scoring on relevance, importance, and clarity of each item in measuring the overarching construct. The item-level content validity index (I-CVI) and the scale-level content validity index (S-CVI) were calculated. The factor structure and internal consistency reliability of SCADS were estimated using principal component analysis (PCA) and Cronbach's alpha, respectively. Results: Both S-CVI/UA (universal agreement) and the average item-level content validity index (S-CVI/Ave) (average) for the entire instrument showed excellent criteria with a value of >0.90. Cronbach's alpha coefficient value for SCADS was 0.707 indicating good internal consistency. All items showed corrected item-total correlation coefficients above 0.244. Questionnaire items with a factor loading of 0.30 or above were considered in the final factor solution. The factor analysis resulted in 3-factor solutions, which corresponded to 66.62% of the total variance. Conclusion: The SCADS is a consistent and reliable instrument for evaluating adherence among IA patients using the subcutaneous bDMARDs. It is simple to use, yet comprehensive but still requiring further clinical and international validation.
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Affiliation(s)
- Salmi Abdul Razak
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Hospital Tuanku Ja'afar Seremban, Seremban, Malaysia
| | - Mohd Makmor Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Chai-Eng Tan
- Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Adyani Md Redzuan
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Abramkin AA, Lisitsyna TA, Veltishchev DY, Seravina OF, Kovalevskaya OB, Glukhova SI, Nasonov EL. [Depression and severity of articular destruction in patients with rheumatoid arthritis]. TERAPEVT ARKH 2020; 92:22-32. [PMID: 32598772 DOI: 10.26442/00403660.2020.05.000624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Indexed: 11/22/2022]
Abstract
AIM To assess the influence of anxiety and depressive disorders on joint destruction in patients with rheumatoid arthritis (RA). MATERIALS AND METHODS 128 RA-patients were included, 87% were women with a mean age of 47.411.3 years and a median of RA duration 96 [48; 228] months. At the inclusion most patients had moderate (n=56, 43.7%) and severe (n=48, 37.5%) disease activity according to DAS28. Joint destruction was classified as maximal in patients with radiographic stage III, IV and/or osteonecrosis) and minimal in patients with stage I, II and no osteonecrosis. Pain intensity was measured with the BPI (Brief Pain Inventory) scale, severity of fatigue with fatigue severity scale (FSS), clinically important fatigue was diagnosed in patients with FSS4. Anxiety and depressive disorders (ADD) were diagnosed by a licensed psychiatrist in 123 (96.1%) of RA-patients in accordance with ICD-10 in semi-structured interview. Severity of depression and anxiety was evaluated with Montgomery-Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HAM-A). RA-patients with ADD were divided into the following treatment groups: 1 сDMARDs (n=39), 2 сDMARDs+PPT (sertraline or mianserine), n=43, 3 сDMARDs+bDMARDs (n=32), 4 сDMARDs+bDMARDs+PPT (sertraline or mianserine), n=9. Biologics treatment duration varied from 1 to 6 years, antidepressants from 6 to 96 weeks. 83 (67.5%) RA patients were assessed at five-years follow-up. Linear regression analysis was conducted to determine factors associated with maximal join destruction. RESULTS According to linear regression analysis, maximal joint destruction at 5 years follow-up was associated with higher baseline BPImax, longer RA and ADD duration, clinically important fatigue at baseline, baseline extraarticular RA manifestations, recurrent depressive disorder at 5-years follow-up and treatment with cDMARDs only. CONCLUSION Recurrent depressive disorder without antidepressant treatment is an important predictor of progression of joint destruction in patients with rheumatoid arthritis.
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Affiliation(s)
| | | | - D Y Veltishchev
- Moscow Research Institute of Psychiatry - branch of the Serbskiy National Medical Research Center of Psychiatry and Narcology.,Pirogov Russian National Research Medical University
| | - O F Seravina
- Moscow Research Institute of Psychiatry - branch of the Serbskiy National Medical Research Center of Psychiatry and Narcology
| | - O B Kovalevskaya
- Moscow Research Institute of Psychiatry - branch of the Serbskiy National Medical Research Center of Psychiatry and Narcology
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One-third of patients are low-adherent to methotrexate for rheumatoid arthritis at the initiation of a first biologic. A cross-sectional study investigating adherence rate and factors. Joint Bone Spine 2020; 87:668-669. [PMID: 32445934 DOI: 10.1016/j.jbspin.2020.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/30/2020] [Indexed: 11/21/2022]
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Hope HF, Hyrich KL, Anderson J, Bluett J, Sergeant JC, Barton A, Cordingley L, Verstappen SMM. The predictors of and reasons for non-adherence in an observational cohort of patients with rheumatoid arthritis commencing methotrexate. Rheumatology (Oxford) 2020; 59:213-223. [PMID: 31302692 DOI: 10.1093/rheumatology/kez274] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/24/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE In order to develop interventions to optimize MTX use for the treatment of RA we evaluated the rate of, reasons for and predictors of MTX non-adherence during the first 6 months of therapy. METHODS The Rheumatoid Arthritis Medication Study (RAMS) is a prospective multicentre cohort study of incident MTX users in the UK. Prior to MTX commencement demographic, clinical and psychological data were collected. A weekly patient-completed diary recorded MTX dose, possible side effects and adherence over 26 weeks. The number of non-adherent weeks was calculated. Potential baseline predictors of ever non-adherence (⩾1 week non-adherent) during the first 6 months of MTX therapy were identified using logistic regression analyses. RESULTS 606 patients with RA were included; 69% female, mean (s.d.) age 60 (13) years and DAS28 score 4.2 (1.2). Over the first 6 months following MTX initiation, 158 (26%) patients were ever non-adherent (71% intentional, 19% non-intentional, 10% unexplained) and mean (s.d.) number of non-adherent weeks was 2.5 (2.1). Multivariable predictors of ever non-adherence included DAS28 [odds ratios (OR) 1.1, 95% CI 1.0, 1.4], fatigue (OR 1.1, 95% CI 1.0, 1.2 per cm), ⩾2 comorbidities vs no comorbidities (OR 1.9, 95% CI 1.1, 3.5) and high medication concerns despite perceived need (OR 1.1, 95% CI 1.0, 1.1 per unit decrease in need/concern differential). CONCLUSION This is the largest study evaluating early intentional and non-intentional non-adherence to MTX, which has identified that patient beliefs and multi-morbidity strongly link with non-adherence. These findings can direct the design of and provide potential targets for interventions to improve patient adherence.
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Affiliation(s)
- Holly F Hope
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,NIHR Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Kimme L Hyrich
- NIHR Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Arthritis Research UK Centre for Epidemiology, Manchester, UK
| | - James Anderson
- Arthritis Research UK Centre for Genetics and Genomics, Faculty of Biology, Medicine and Health, Manchester, UK
| | - James Bluett
- NIHR Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Arthritis Research UK Centre for Genetics and Genomics, Faculty of Biology, Medicine and Health, Manchester, UK
| | - Jamie C Sergeant
- Arthritis Research UK Centre for Epidemiology, Manchester, UK.,Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Anne Barton
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Arthritis Research UK Centre for Genetics and Genomics, Faculty of Biology, Medicine and Health, Manchester, UK
| | - Lis Cordingley
- NIHR Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Arthritis Research UK Centre for Epidemiology, Manchester, UK
| | - Suzanne M M Verstappen
- NIHR Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Arthritis Research UK Centre for Epidemiology, Manchester, UK
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Mary A, Boursier A, Desailly Henry I, Grados F, Séjourné A, Salomon S, Fardellone P, Brazier M, Goëb V. Mobile Phone Text Messages and Effect on Treatment Adherence in Patients Taking Methotrexate for Rheumatoid Arthritis: A Randomized Pilot Study. Arthritis Care Res (Hoboken) 2020; 71:1344-1352. [PMID: 30192070 DOI: 10.1002/acr.23750] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 09/04/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To assess the impact of weekly text messages on adherence in patients taking methotrexate (MTX) for rheumatoid arthritis (RA). METHODS This prospective, randomized pilot, single-site study included patients with RA stabilized using MTX alone or combined with biologics. Participants were randomized to 3 interventions: a standard consultation (controls), a 15-minute pharmacist-led counseling session, or the receipt of text message reminders. The change over time in the Compliance Questionnaire Rheumatology (CQR-19) score between baseline and 6 months was defined as the primary outcome for adherence. Multivariable analyses and final adherence (as a composite outcome of the CQR-19 score, the Girerd score, and the medication possession ratio) were probed in sensitivity tests. Rheumatologic scales, inflammation, and patient satisfaction were also analyzed. RESULTS A total of 96 patients (mean ± SD Disease Activity Score in 28 joints 2.42 ± 1.03) were monitored. The change over time in the CQR-19 score was significantly higher in the text message group (mean ± SD 3.32 ± 5.66; P = 0.02) than in the control group (mean ± SD 0.22 ± 6.56) and the pharmacist-led counseling group (mean ± SD -0.14 ± 7.56). Multivariable logistic regression showed that text messages remained associated with an increase in the CQR-19 score, independently of the baseline CQR-19 score (odds ratio 3.63 [95% confidence interval 1.26-10.49]; P = 0.017). In the text message group, the increase in the CQR-19 score was correlated with the Health Assessment Questionnaire score (r = -0.405, P = 0.021), and patient satisfaction was significantly higher (P < 0.01) than in the control group. CONCLUSION Our results showed evidence of a positive impact of text messages on adherence to MTX treatment for RA. The clinical benefit and the ideal target patient remain to be determined.
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Affiliation(s)
- Aurélien Mary
- Amiens Picardie University Hospital, Inserm 1088, and Picardie Jules Verne University, Amiens, France
| | | | | | | | | | | | - Patrice Fardellone
- Inserm 1088, Picardie Jules Verne University, and Amiens Picardie University Hospital, Amiens, France
| | - Michel Brazier
- Amiens Picardie University Hospital, Inserm 1088, and Picardie Jules Verne University, Amiens, France
| | - Vincent Goëb
- Picardie Jules Verne University, and EA 4666, Amiens, France
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Abstract
Introduction: Despite improvement in disease outcomes and prognosis, a substantial number of patients with rheumatoid arthritis (RA) still require a novel agent for effective treatment. Baricitinib is a targeted synthetic disease-modifying antirheumatic drug (tsDMARDs) that selectively inhibits Janus kinase (JAK1/JAK2), an important enzyme in the pathogenesis of RA.Areas covered: This paper aimed to evaluate the pharmacodynamics and pharmacokinetics of baricitinib while reviewing its safety and efficacy in the treatment of RA.Expert opinion: Randomized controlled trials of baricitinib showed its efficacy and safety in patients with active RA who were methotrexate (MTX)-naïve or were not adequately responsive to MTX, conventional synthetic DMARDs, or tumor necrosis factor inhibitors. Baricitinib may be suitable in patients who prefer oral therapy and do not have a history of severe renal impairment, recent history of malignancy, or risk factors for adverse events (AEs) such as venous thromboembolism, opportunistic infection, and diverticulitis. Dose adjustment of baricitinib, based on the assessment of patient conditions including their renal function and disease activity, is an important strategy for successful and safe treatment. However, long-term post-marketing surveillance studies with a larger sample size are required to evaluate the overall safety and AEs with low incidence rates in clinical settings.
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Affiliation(s)
- Suguru Honda
- Department of Rheumatology, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Masayoshi Harigai
- Department of Rheumatology, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
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Studenic P, Aletaha D. The slippery road of adherence in chronically ill individuals. Rheumatology (Oxford) 2019; 59:9-11. [DOI: 10.1093/rheumatology/kez495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Paul Studenic
- Division of Rheumatology, Department of Internal Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Department of Internal Medicine 3, Medical University of Vienna, Vienna, Austria
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López-Medina C, Moltó A, Gérald F, Dubremetz M, Grange L, Thibaud G, Charles B, Lafarge D, Beauvais C, Gossec L, Dougados M. Assessment of the adherence to disease-modifying drugs in patients with chronic inflammatory rheumatic diseases: Results of a survey of 1594 patients. Joint Bone Spine 2019; 86:610-614. [DOI: 10.1016/j.jbspin.2019.01.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/30/2019] [Indexed: 12/22/2022]
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50
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Could a methotrexate blood assay improve adherence? Nat Rev Rheumatol 2019; 15:577-578. [DOI: 10.1038/s41584-019-0291-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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