Betegnie AL, Gauchet A, Lehmann A, Grange L, Roustit M,
Baudrant M, Bedouch P, Allenet B. Why Do Patients with Chronic Inflammatory
Rheumatic Diseases Discontinue Their Biologics? An Assessment of Patients'
Adherence Using a Self-report Questionnaire. J Rheumatol. 2016 Feb 15.
Abstract
OBJECTIVE:
Concerns have been raised about nonadherence behavior among
patients with chronic inflammatory rheumatic diseases (CIRD) receiving
biologics. This nonadherence may be caused by various factors. The main
objective was to explain why patients discontinue their biologics of their own
accord.
METHODS:
A quantitative and descriptive study was performed using a
self-report questionnaire that was sent through the Internet to members of
different patient associations. Sociodemographic data, medical and therapeutic
history, management of biologic administration, previous experiences, and
patients' beliefs and perceptions about treatment efficacy and side effects
were studied to explain self-discontinuation (SD).
RESULTS:
A total of 581 patients answered the questionnaire between
June 16, 2012, and July 4, 2012, including patients with ankylosing spondylitis
(351/581, 60.4%), rheumatoid arthritis (196/581, 33.7%), psoriatic arthritis
(30/581, 5.2%), and other CIRD (4/581, 0.7%). More than 1000 different
biologics were described by the 581 patients, with a median of 2 lines per
patient. Eighty-six patients discontinued their biologics of their own accord
(14.8%). In a multivariate analysis, factors that were significantly related to
SD were low level of pain, more than 1 line of biologics tried,
self-administration of biologics, negative beliefs about the treatment, and a
lack of medical and social support.
CONCLUSION:
Five predictive factors of this SD were identified, which
should be assessed in routine with patients with CIRD receiving biologic
treatment: pain, treatment history, self-administration of injections, negative
beliefs about treatment, and a lack of perceived medical and social support.
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From the paper:
The first factor related to SD in our study was pain. The more
pain the patient experienced, the better their adherence to their biologic.
This correlation was independent of the type of disease. Similar results have
been reported in fibromyalgia. However, pain was measured over the last 8 days,
while participants may have discontinued their biologics far longer ago.
Further investigation should analyze the evolution of pain during time and its
link to adherence. Relief from pain could be interpreted by the patient as a
remission, which may lead to discontinuation. In contrast, pain leading up to
the next injection may be perceived as a treatment efficacy, which is the most
influential factor for longterm persistence according to Brod, et al.
The duration of therapy seems to be a major component of
adherence. Our results show that the number of different lines of therapy tried
by the patient is an independent factor for discontinuation. Persistence to
biologic treatments decreases with time, as Koncz, et al reported in a review
of the literature.
According to the literature, the previous experience of side
effects is also a major driver of discontinuation. In our study, more than 70%
of patients declared having already felt side effects. However, no significant
correlation with SD was found.
There is little evidence of the link between CAM and adherence.
Our univariate analysis suggests that patients who self-discontinued were more
likely to use CAM than others. Westhoff and Zink showed that a preference for
CAM was the strongest risk predictor of lack of adherence to DMARD (conventional
disease-modifying antirheumatic drugs) therapy among patients with RA. In our
multivariate model, this relationship does not remain significant.
In our study, patients who self-administered their biologics were also more predisposed to discontinue
their biologics compared with patients whose injection was given by someone
else. A qualitative study has suggested that the most critical period
concerning adherence to self-injectable treatment is the first month of therapy.
During this period, patients need encouragement and support to continue
selfadministered treatment.
The relationship between drug adherence and beliefs about medication
among patients with RA was described by Neame, et al using the Belief about
Medicines Questionnaire. In line with this, we concluded a significant
correlation between negative beliefs and SD (impression that treatment hurts
more than does good, and that it is like a poison).
Further, we found that medical and social support were significantly
related to SD, which suggests that a supportive environment may improve
adherence to a biologic. Regarding internal resources, we found no significant
correlation between self-efficacy and SD in our study, although the literature
reports this factor as an important determinant of adherence. However, de
Klerk, et al and Brus, et al assessed self-efficacy among patients with
conventional DMARD drugs only and did not use the same questionnaire.
Courtesy of : http://www.hcplive.com/medical-news/5-factors-that-predict-medication-nonadherence-in-patients-taking-biologics-for-rheumatic-disease/P-1
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