Addressing the Challenge of Nonadherence in Rheumatic Diseases

Among patients with rheumatic diseases, medication nonadherence remains a significant problem because of a lack of standardization and guidance on terminology, measurement, and outcome selection, according to an abstract presented at the European Congress of Rheumatology of the European League Against Rheumatism.¹

The authors interviewed 13 researchers to understand their perspectives and experiences on adherence intervention research and outcomes in rheumatology. The researchers interviewed had been an investigator on an adherence study in the past 10 years. They represented 7 countries—Australia, Belgium, Canada, the Netherlands, Thailand, the United Kingdom, and the United States—and a majority worked in academic (75%).

The researchers identified 3 themes:

1. Challenges in conducting and evaluating interventional studies targeting adherence, including difficulties conducting sufficiently powered studies, a lack of guidance on selecting outcomes, and poor description of adherence interventions
2. Recommendations for improving the measurement of adherence, including considering all phases of adherence (initiation, implementation, and persistence), establishing clinically meaningful thresholds, and addressing limitations of current adherence measures
3. Improving outcome assessment in adherence intervention studies by establishing a core domain set to make trials more comparable, ensuring relevance of outcomes across different contexts, and engaging and representing priorities of different stakeholders

“Our findings form the basis for recommendations for improving the design, conduct, and evaluation of adherence intervention studies in rheumatology, particularly for developing a core domain set of outcomes to improve consistency and facilitate comparisons,” the authors concluded.

In a separate abstract, researchers from Spain sought to understand the patient’s perspective regarding nonadherence.² According to the authors, the nonadherence rate in patients with RA ranges between 20% and 50%, and poor adherence has a negative impact on outcomes.

The authors included 144 patients with rheumatoid arthritis (RA) in a cross-sectional study and used the Compliance Questionnaire Rheumatology to assess treatment adherence and the Brief Illness Perception Questionnaire and the Beliefs About Medicine Questionnaire to evaluate illness and medication beliefs.

The belief that the drugs can cause potential damage was associated with poor compliance while the belief that the medication was necessary was associated with good compliance. Patients who had a feeling of treatment control were more likely to be adherent, as were patients with a greater emotional response.

“Illness and medication beliefs could influence compliance to treatment in patients with RA,” the authors concluded.

References

1. Kelly A, Salmasi S, Bartlett SJ, et al. Researchers’ perspectives on adherence intervention research and outcomes in rheumatology: An international qualitative study. Presented at: EULAR 2020; June 3-6, 2020; Abstract THU0565. https://ard.bmj.com/content/79/Suppl_1/524.2

2. Ahijón M, Carreira P, De La Cruz C, Veiga R, Gutierrez C. Implicated factors in therapeutic adherence of patients with rheumatoid arthritis: the patient’s perspective. Presented at: EULAR 2020; June 3-6, 2020; Abstract SAT0616-HPR. https://ard.bmj.com/content/79/Suppl_1/1268.1