Abstract
Purpose
Proper adherence and persistence to medications are crucial for better quality of life and improved outcomes in rheumatoid arthritis (RA), psoriasis (PsO), and psoriatic arthritis (PsA). We systematically describe current adherence and persistence patterns for RA, PsO, and PsA, with a focus on biologics and identifying factors associated with adherence and persistence.
Patients and methods
Using various databases, a systematic literature review of US-based studies published from 2000 to 2015 on medication adherence and persistence to biologics and associated factors was conducted among patients with RA, PsO, and PsA.
Results
Using the medication possession ratio or the percentage of days covered >80%, RA and PsO adherence rates for etanercept, adalimumab, and infliximab ranged from 16% to 73%, 21% to 70%, and 38% to 81%, respectively. Using the criteria of a ≥45-day gap, RA persistence rates for etanercept, adalimumab, and infliximab ranged from 46% to 89%, 42% to 94%, and 41% to 76%, respectively. In PsO, persistence rates for etanercept and adalimumab ranged from 34% to 50% and 50% to 62%, respectively. Similar persistence rates were observed in PsA. Experienced biologics users showed better adherence and persistence. Younger age, female gender, higher out-of-pocket costs, greater disease severity, and more comorbidities were associated with lower adherence and persistence rates. Qualitative surveys revealed that nonpersistence was partly due to perceived ineffectiveness and safety/tolerability concerns.
Conclusion
Biologic adherence and persistence rates in RA, PsO, and PsA in the United States were low, with significant opportunity for improvement. Various factors – including decrease in disease severity; reduction of comorbidities; lower out-of-pocket costs; refilling at specialty pharmacies; and awareness of drug effectiveness, safety, and tolerability – can inform targeted approaches to improve these rates.
Supplementary materials
Search strategy.
e-Pub search in PubMed, January 12, 2016
(((((((“Arthritis, Rheumatoid”[Mesh:noexp]) OR (“Rheumatoid Nodule”[Mesh:noexp]) OR (“Psoriasis”[Mesh:noexp]) OR (“Arthritis, Psoriatic”[Mesh:noexp]) OR (rheumatoid nodule*[tiab]) OR (arthritis rheumat*[tiab]) OR (RA[tiab]) OR (psoria*[tiab]) OR (psoriatic arthrit*[tiab]))))) AND ((((“Medication Adherence”[Mesh:noexp]) OR (“Patient Compliance”[Mesh:noexp]) OR (“Treat-ment Refusal” [Mesh: noexp]) O R (“Patient Dropouts”[Mesh:noexp]) OR (adher*[tiab]) OR (complian*[tiab]) OR (persist*[tiab]) OR (cooperat*[tiab]) OR (co-operat*[tiab]) OR (treatment refusal[tiab]) OR (patient dropout*[tiab]) OR (nonadher*[tiab]) OR (non-adher*[tiab]) OR (non-persist*[tiab]) OR (nonpersist*[tiab]) OR (noncomplian*[tiab]) OR (non-complian*[tiab]) OR (uncooperat*[tiab]) OR (unco-operat*[tiab]) OR (patient perspective*[tiab]) OR (patient attitude*[tiab]) OR (patient experience*[tiab]) OR (continuation rate*[tiab]) OR (assessment adher*[tiab]) OR (assessment complian*[tiab]) OR (assessment persist*[tiab]) OR (assessment nonadher*[tiab]) OR (assessment non-adher*[tiab]) OR (assessment noncomplian*[tiab]) OR (assessment non-complian*[tiab]) OR (assessment nonpersist*[tiab]) OR (assessment non-persist*[tiab])))))) AND ((publisher[sb] NOT pubstatusnihms[All Fields] NOT pubstatuspmcsd[All Fields] NOT pmcbook[All Fields]) OR pubstatusaheadofprint[All Fields])
Search Result: 87
Embase 1974 to 2015 December 28, 2015 using OvidSp
Ovid Medline (R) in-process and other non-indexed citations and Ovid and Medline (R) 1946 – December 28, 2015 using OvidSp
Cochrane, December 28, 2015 (CENTRAL only)
Acknowledgments
We are grateful to Michael Friedman for providing thorough data integrity review of the manuscript. The study was funded by Eli Lilly and Company. Abstract and poster presented at AMCP Nexus 2016 (https://www.jmcp.org/doi/pdf/10.18553/jmcp.2016.22.issue-10-a).
Disclosure
MJM, WNM, CL, TM, RTB, and ABA are employees and stockholders of Eli Lilly and Company. VT, CB, NJ, and SC are employees of ICON plc, which received funding from Eli Lilly and Company to conduct the study. SRF is an employee of the Wake Forest University School of Medicine and has received research, speaking, and consulting support from AbbVie, Celgene, Janssen, Lilly, and Novartis. The authors report no other conflicts of interest in this work.