Methotrexate Adherence Still Suboptimal

Patients still have reservations about methotrexate, shows a new study in ACR Open Rheumatology. (©UnguryanuShutterstock.com)

In patients with rheumatoid arthritis, methotrexate adherence is suboptimal and associated with certain demographics, medication experience, and beliefs about medicines, say researchers writing in ACR Open Rheumatology this month.

Methotrexate is the gold standard and primary initial treatment for rheumatoid arthritis, and while use is common, patients may experience adverse events or inadequate efficacy, which may influence treatment adherence. Poor medication adherence in rheumatoid arthritis has been associated with worse outcomes, such as accelerated disease progression, while over compliance may lead to more adverse events. As treatment strategies encourage more aggressive dose alterations and therapy switching to achieve lower disease activity, the assessment of methotrexate adherence in a broad population and in a non-clinical setting is needed to gain a better understanding.

Researchers conducted an observational study in a real-world setting assessing 24‐week treatment adherence to oral methotrexate in 60 patients newly treated for rheumatoid arthritis, using the Medication Event Monitoring System, which registers electronically when the medication bottle cap is removed, to assess treatment adherence and characterize adherence patterns.

Respective methotrexate adherence, implementation, and persistence were 75 percent, 80 percent, and 83 percent at 24 weeks. Less disability and higher Patient Global scores were associated with correct dosing in the overall adherence period, while unemployment and having no prior conventional synthetic disease‐modifying antirheumatic drug experience were connected to the number of weeks of correct dosing.

“Our results should help inform physicians of the different stages of adherence, and as different factors may affect adherence during these stages, this study should provide insight into how a thoughtful intervention at each stage could enhance adherence,” wrote the authors. lead by Kaleb Michaud, Ph.D., of the University of Nebraska.

“Physicians could make use of tools, such as the BMQ, to understand their patients' concerns and beliefs about medications prior to treatment initiation, and follow up with patients if they observe that methotrexate has not been refilled on time,” the authors wrote.

REFERENCEMichaud, K. , Vrijens, B. , Tousset, E., et al. “Real‐World Adherence to Oral Methotrexate Measured Electronically in Patients With Established Rheumatoid Arthritis.” ACR Open Rheumatology. September 6, 2019. doi:10.1002/acr2.11079