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Aksoy N, Ozturk N, Agh T, Kardas P. Adherence to the antirheumatic drugs: a systematic review and meta-analysis. Front Med (Lausanne) 2024; 11:1456251. [PMID: 39328321 PMCID: PMC11424425 DOI: 10.3389/fmed.2024.1456251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 08/29/2024] [Indexed: 09/28/2024] Open
Abstract
Introduction This systematic review and meta-analysis aimed to analyze the adherence rate for conventional and biological disease-modifying antirheumatic drugs (DMARDs) utilizing different assessment measures. Method A systematic literature search was performed in four electronic databases, including PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL), covering the time frame from April 1970 to April 2023. Studies that present data on medication adherence among adult patients with rheumatoid arthritis (RA), specifically focusing on DMARDs (conventional or biological), were included in the analysis. The adherence rate for different assessment measures was documented and compared, as well as for conventional and biological DMARDs. A random-effects meta-analysis was performed to assess adherence rates across different adherence assessment measures and drug groups. Results The search identified 8,480 studies, out of which 66 were finally included in the analysis. The studies included in this meta-analysis had adherence rates ranging from 12 to 98.6%. Adherence rates varied across several adherent measures and calculation methods. Using the subjective assessment measures yielded the outcomes in terms of adherence rate: 64.0% [0.524, 95% CI 0.374-0.675] for interviews and 60.0% [0.611, 95% CI 0.465-0.758] for self-reported measures (e.g., compliance questionnaires on rheumatology CQR-5), p > 0.05. In contrast, the objective measurements indicated a lower adherence rate of 54.4% when using the medication event monitoring system (p > 0.05). The recorded rate of adherence to biological DMARDs was 45.3% [0.573, 95% CI 0.516-0.631], whereas the adherence rate for conventional DMARDs was 51.5% [0.632, 95% CI 0.537-0.727], p > 0.05. In the meta-regression analysis, the covariate "Country of origin" shows a statistically significant (p = 0.003) negative effect with a point estimate of -0.36, SE (0.12), 95% CI, -0.61 to -0.12. Discussion Despite its seemingly insignificant factors that affect the adherence rate, this meta-analysis reveals variation in adherence rate within the types of studies conducted, the methodology used to measure adherence, and for different antirheumatic drugs. Further research is needed to validate the findings of this meta-analysis before applying them to clinical practice and scientific research. In order to secure high reliability of adherence studies, compliance with available reporting guidelines for medication adherence research is more than advisable.
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Affiliation(s)
- Nilay Aksoy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Altınbaş University, Istanbul, Türkiye
| | - Nur Ozturk
- Graduate School of Health Sciences, Clinical Pharmacy PhD Program, Istanbul Medipol University, Istanbul, Türkiye
| | - Tamas Agh
- Syreon Research Institute, Budapest, Hungary
- Medication Adherence Research Group, Center for Health Technology Assessment and Pharmacoeconomic Research, University of Pécs, Pécs, Hungary
| | - Przemyslaw Kardas
- Medication Adherence Research Centre, Department of Family Medicine, Medical University of Lodz, Lodz, Poland
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Mohamed M, El-Maboud A, Salem HF, Salem MN, Elmaaty MA, Eissa N, Said ASA, Hussein RRS. Predictors of methotrexate adherence and patient's awareness of it in rheumatoid arthritis and its effect on quality of life. J Pharm Policy Pract 2024; 17:2365933. [PMID: 39035456 PMCID: PMC11259066 DOI: 10.1080/20523211.2024.2365933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 06/04/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction Adherence studies among rheumatoid arthritis (RA) patients, in Egypt and throughout the Middle East region, are lacking. This study aimed to evaluate methotrexate (MTX) adherence in Rheumatoid arthritis (RA) patients and to identify specific non-adherence predictors. Methods A cross-sectional observational study included 300 RA patients who were administered MTX for at least one year. The survey was completed through direct interviews. The demographic patient data were collected (age, education, sex, work status, disease duration, duration of MTX administration and current dose). Patients' adherence to MTX predictors for non-adherence, MTX side effects and functional disability were assessed in the study. Results Majority of respondents showed good MTX adherence, and more than 50% of patient's experienced MTX side effects. A large percentage of participants showed low knowledge about MTX nature and side effects. Most participants reported no or some difficulty in quality of life-related activities and functional disability. Conclusion MTX adherence and awareness were positively correlated to many variables, including, age, educational level and disease duration, which in turn has its positive impact on the patient's quality of life. Still, more research is needed to determine the impact of non-adherence on the patient's health outcomes.
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Affiliation(s)
- Marwa Mohamed
- Clinical Pharmacist at Medical Administration, Fayoum University, Egypt
| | - Abd El-Maboud
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Cairo, Egypt
| | - Heba F. Salem
- Department of Pharmaceutics & Industrial Pharmacy, Faculty of Pharmacy, Beni-Suef University, Cairo, Egypt
| | - Mohamed N. Salem
- Department of Internal Medicine, Faculty of Medicine, Beni-Suef University, Cairo, Egypt
| | - Mahmoud Abo Elmaaty
- Senior Clinical Pharmacist at the Children Cancer Hospital in Egypt, Beni-Suef University, Cairo, Egypt
| | - Nermin Eissa
- Department of Biomedical Sciences, College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Amira S. A. Said
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Cairo, Egypt
- Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Raghda R. S. Hussein
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Cairo, Egypt
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Hashmi F, Haroon M, Ullah S, Asif S, Javed S, Tayyab Z. Stress at Home and Female Gender Are Significantly Associated With Non-adherence and Poor Illness Perception Among Patients With Rheumatoid Arthritis. Cureus 2022; 14:e25835. [PMID: 35836440 PMCID: PMC9273195 DOI: 10.7759/cureus.25835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 01/26/2023] Open
Abstract
Aims We aimed to assess the level of non-adherence and poor illness perception among rheumatoid arthritis (RA) patients. Additionally, we examined their associations with clinical indicators and outcomes. Methods This was a cross-sectional study conducted using data collected at the time of patient enrolment in the Pakistan Registry of Rheumatic Diseases (PRIME) registry. A wide range of clinical variables was studied. To measure adherence, we used the Urdu version of the General Medication Adherence Scale (GMAS), which has recently been validated in RA patients. A Brief Illness Perception Questionnaire (BIPQ) was used to measure illness perception. Results The data of consecutive 320 RA patients were reviewed. Thirty-six percent of the cohort (n=116) was noted to have non-adherence. On multiple logistic regression analysis, a significant association of non-adherence was noted with moderate-to-severe stress (odds ratio {OR}: 1.85, confidence interval {CI}: 1.04-3.2), DAS-28 scores (OR: 1.83, CI: 1.52-2.21), Health Assessment Questionnaire (HAQ) scores (OR: 1.77, CI: 1.07-2.92), and deformed joint counts (OR: 1.30, CI: 1.15-1.46). Additionally, non-adherence due to "patient behavior" had a significant association with the male gender (OR: 0.48, CI: 0.26-0.87), unemployment (OR: 1.82, CI: 1.07-3.10), and stress at home (OR: 2.17, CI: 1.35-3.49). Twenty-six percent of the cohort (n=86) was noted to have the most negative illness perception, and on multiple logistic regression analysis, it was significantly associated with male gender (OR: 0.24, CI: 0.11-0.53), age of onset of arthritis (OR: 0.96, CI: 0.94-0.99), and worse HAQ scores (OR: 3.7, CI: 2.2-6.1). Conclusions Important adverse factors contributing to non-adherence and negative illness perception highlighted in this study were stress at home, female gender, and younger age of patients.
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Selected psychological factors and medication adherence in patients with rheumatoid arthritis. Reumatologia 2021; 59:90-97. [PMID: 33976462 PMCID: PMC8103406 DOI: 10.5114/reum.2021.105433] [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: 01/27/2021] [Accepted: 04/06/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives The aim of the study was to determine the relationship between medication adherence (MA) and selected psychological factors in a group of patients with rheumatoid arthritis (RA). Material and methods The cross-sectional study was conducted in four rheumatology outpatient clinics in Silesia, Poland. The tests used were the Medication Adherence Questionnaire (MAQ), the Multidimensional Health Locus of Control Scale (MHLC), the Coping Inventory for Stressful Situations (CISS), and the Mindful Attention Awareness Scale (MAAS). The analysis involved 106 adult patients diagnosed with RA at least 6 months before, who were prescribed medication, with disease at any stage and with stable comorbidities. Software was used to perform analyses of frequency, basic descriptive statistics, including the Kolmogorov-Smirnov test, Student’s t-test for independent samples, intergroup univariate variance, Pearson’s r correlation coefficient, Spearman’s rank correlation ρ coefficient, Fisher’s exact test and stepwise linear regression. Results Powerful Others Health Locus of Control (PHLC), Internal Health Locus of Control (IHLC) and age of the subjects, F(3, 102) = 8.05; p < 0.001 explained 16.8% of the variation in the adherence level for the entire group. In the group of women PHLC and IHLC, F(2, 80) = 10.04; p < 0.001 were included in the model, which explained 18.1% of variation in MA. PHLC was the most significant factor in the group of women (β = 0.55; p < 0.001) and in the entire group (β = 0.48; p < 0.001). In the group of men, Social Diversion Style (SDS), F(1, 21) = 5.81; p = 0.02 was included in the model, which explained 17.9% of the variation in the MA level. Conclusions The study identified some psychological predictors of adherence, which explained 16.8% of the variability. Factors increasing the likelihood of medication adherence in patients with rheumatoid arthritis include a strong belief in the power of others, low level of internal health locus of control, and advanced age.
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Mahran SA, Khedr TM, Mohammed EM, El-Hakeim EMH. Medication adherence to disease-modifying anti-rheumatic drugs among patients with rheumatoid arthritis at Assiut University Hospital, Egypt. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2020. [DOI: 10.1186/s43166-020-00005-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abstract
Background
Rheumatoid arthritis is a chronic disabling autoimmune disease with predilection to synovial joints and many extraarticular manifestations. Disease-modifying anti-rheumatic drugs are the cornerstone and initial therapy in rheumatoid arthritis. Although medication adherence is crucial for successful therapy, non-adherence is a substantial problem in some. This study aimed to determine the adherence rate of treatment with disease-modifying anti-rheumatic drugs among patients with rheumatoid arthritis in an Egyptian university hospital. In this study, seventy-three adult rheumatoid arthritis patients who are on disease-modifying anti-rheumatic drugs treatment for at least 6 months were included in this study. After full history and clinical examination, assessment of the adherence rate to disease-modifying anti-rheumatic drugs was done using the Clinician Rating Scale. Measuring the quality of life using the Health Assessment Questionnaire Disability Index and screening for depression and anxiety using the Hospital Anxiety and Depression Scale were done. The socio-economic level of the patients was assessed by socio-economic status scale.
Results
In the current study, 65.1% of the patients were highly adherent to their disease-modifying anti-rheumatic drug (DMARD) medications, while 26% showed middle level of adherence. There was a significant difference between medication adherence and anxiety, but not with other demographic data, clinical data, disease activity, or socio-economic level.
Conclusion
In this study, no significant difference was found between medication adherence and demographic, clinical, or socio-economic data. However, anxiety was significantly related to DMARD adherence in the studied group. Age and HAQ-DI were found to be strong predictors to medication adherence in our RA patients. Further studies should be conducted on a large number of patients with rheumatoid arthritis to become generalizable to a broader population.
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Conrozier T, Renevier JL, Parisaux JM, Balblanc JC. Predictive factors of adherence to an association of glucosamine sulfate, copper, and ginger extracts in patients with symptomatic osteoarthritis: a prospective open-label French noninterventional study (the PREDOA study). Patient Prefer Adherence 2019; 13:915-921. [PMID: 31239649 PMCID: PMC6559715 DOI: 10.2147/ppa.s200892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/02/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Osteoarthritis (OA) management needs a combination of nonpharmacological and pharmacological modalities. However, as in many chronic conditions, the main concern with OA therapy is the difficulty in obtaining good medication compliance over a long period. The PREDOA study aimed to investigate the predictive factors of adherence to treatment in patients with OA treated with glucosamine sulfate (GS)-copper sulfate-ginger root (GCu), a symptomatic slow-acting drug for OA. Methods: Ambulatory patients with a clinical diagnosis of OA were included in a prospective (6 months) multicenter open-label observational study. All patients received two capsules of GS-GCu once daily for 6 months. Demographics, disease features (OA location, symptom duration, concomitant therapies, comorbidities), and patient self-assessment of pain (0-10) were obtained at baseline. At month 6, the investigator collected patient self-assessments of treatment observance, reasons for nonadherence, pain scores, patient perceptions of treatment efficacy, changes in analgesic intake, and occurrence of adverse events. Predictors of observance were studied in univariate and multivariate analyses. Results: A total of 2,030 patients were included in the study. At baseline, the average pain score was 6.4±1.7. Observance was good in 80% of patients. It was weaker in active than retired patients (P=0.005) in patients not taking concomitant treatment (P=0.008) or who had never been treated for OA (P=0.001). Observance was correlated with pain decrease (P<0.0001) and with lack of adverse effects (P<0.001). Age, sex, pain level at baseline, OA location, and number of painful joints were not related to treatment compliance. Conclusion: Medication compliance with GS-GCu depends both on the safety-efficacy balance and several patient related-factors. To improve adherence, detailed information about therapeutic objectives is necessary in active patients who do not get any other medications and for whom it is their first treatment for OA. Clinical trial identifier: CCTIRS 14-371 B.
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Affiliation(s)
- Thierry Conrozier
- Service de Rhumatologie, Hôpital Nord Franche-Comté, Belfort, France
- Correspondence: Thierry Conrozier Department of Rheumatology, Hôpital Nord Franche-Comté, 100 route de MOVAL, CS 10499 Trevenans, Belfort, 90015, FranceTel +33 384 982 222Email
| | | | - Jean-Marc Parisaux
- Institut Monégasque de Médecine et Chirurgie Sportive, Monaco, Principauté de Monaco
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Shaw Y, Metes ID, Michaud K, Donohue JM, Roberts MS, Levesque MC, Chang JC. Rheumatoid Arthritis Patients' Motivations for Accepting or Resisting Disease-Modifying Antirheumatic Drug Treatment Regimens. Arthritis Care Res (Hoboken) 2018; 70:533-541. [PMID: 28575542 DOI: 10.1002/acr.23301] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 06/01/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Patient refusal of and nonadherence to treatment with disease-modifying antirheumatic drugs (DMARDs) can adversely affect disease outcomes in rheumatoid arthritis (RA). This qualitative study describes how RA patients' feelings in response to experiences and information affected their decisions to accept (agree to adopt, initiate, and implement) or resist (refuse, avoid, and discontinue) DMARD treatment regimens. METHODS A total of 48 RA patients were interviewed about their experiences making decisions about DMARDs. The interviews were transcribed, coded, and analyzed for themes related to their internal motivations for accepting or resisting treatment regimens, using a narrative analysis approach. RESULTS In addition to feelings about the necessity and dangers of medications, patients' feelings towards their identity as an ill person, the act of taking medication, and the decision process itself were important drivers of patient's decisions. For patients' motivations to accept treatment regimens, 2 themes emerged: a desire to return to a normal life, and fear of future disability due to RA. For motivations to resist treatment regimens, 5 themes emerged: fear of medications, maintaining control over health, denial of sick identity, disappointment with treatment, and feeling overwhelmed by the cognitive burden of deciding. CONCLUSION Feelings in response to experiences and information played a major role in how patients weighed the benefits and costs of treatment options, suggesting that addressing patients' feelings may be important when rheumatologists counsel about therapeutic options. Further research is needed to learn how best to address patients' feelings throughout the treatment decision-making process.
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Affiliation(s)
- Yomei Shaw
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Ilinca D Metes
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and National Data Bank for Rheumatic Diseases, Wichita, Kansas
| | - Julie M Donohue
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Mark S Roberts
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | | | - Judy C Chang
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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