Link Between Lower Healthcare Resource Utilization and Adherence to DMARD Therapy in RA Patients

In recent years, biologic disease-modifying antirheumatic drugs (DMARDs) have advanced the treatment of rheumatoid arthritis (RA). However, poor adherence to treatments have increased the patient and society burden of the chronic disease.

A recent study investigated the long-term healthcare resource utilization patterns of patients with RA by comparing those who were adherent to the biologic DMARD therapy to those who were nonadherent in attempt to identify factors that influence adherence.

The participants included in the study were at least 65 years old and in the Ontario Rheumatoid Arthritis Database with a prescription for a biologic DMARD between January 1, 2003, and December 31, 2013. Adherence was defined at the proportion of days that a patient had a biologic treatment over the total overall follow-up period. Using the medication possession ratio (MPR)—MPR = (Days supplied for the drug of interest/ Follow-up time)—patients were considered adherent if they had an MPR of at least 0.8.

Of a total of 4666 RA patients, 2749 (59%) were considered adherent, while 1917 (41%) were considered nonadherent. Adherent patients were significantly younger than the average and often had a higher income than nonadherent patients. Rates of resource use, physician visits, emergency visits, hospitalization, home care, and rehabilitation, were significantly lower in adherent patients, but nonadherent patients’ use of oral prednisone (67%) was significantly greater than the adherent patients (56%).

“Being adherent to biologic DMARD therapy was associated with a significant reduction in all health care resource utilization outcomes measured, except for visits to a rheumatologist, which was slightly greater in adherent patients” the authors wrote. “A previous study investigating adherence to anti-TNF therapy also found that adherent patients had 21.5% reduction in mean annual non-pharmacological expenditure for each patient, a rate almost identical to what we found in this study.”

These results suggest that adherence to biologic DMARD therapy may be associated with lower healthcare resource utilization among RA patients. The researchers emphasize the importance of adherence to therapies when managing all chronic diseases, including RA.