Adherence to Subcutaneous Anti-TNF Treatment in Chronic Inflammatory Rheumatism and Therapeutic Patient Education

Figures & data

Table 1 Characteristics of Patients According to Their Educational Model

	Model 1 N = 92	Model 2 N = 80	Model 3 N = 21	p-value
Gender Female, n (%)	55 (59.8)	51 (63.8)	18 (85.7)	0.08
Age, mean ± SD	54.1 ± 15.6	51.5 ± 14.1	57.0 ± 13.4	0.24
Education, n (%)
Elementary school	10 (11.2)	3 (3.7)	3 (15.0)	0.15
Middle school	18 (20.2)	19 (23.8)	5 (25.0)
High school	34 (38.2)	39 (48.7)	4 (20.0)
University	27 (30.4)	19 (23.8)	8 (40.0)
Socio-professional status, n (%)
Employed	41 (45.0)	46 (59.7)	9 (42.9)	0.16
Retired	31 (34.1)	22 (28.6)	10 (47.6)
Unemployed	19 (20.9)	9 (11.7)	2 (9.5)
Marital status, n (%)
Married/Civil union	55 (64.0)	53 (71.6)	16 (84.2)	0.14
Single	21 (24.4)	19 (25.7)	3 (15.8)
Widowed	10 (11.6)	2 (2.7)	0 (0.0)
Type of care In-hospital, n (%) (vs mixed)	40 (44.4)	35 (44.3)	9 (45.0)	0.99
Pathologies, n (%)
RA	55 (59.8)	41 (51.3)	17 (81.0)	0.09
AS	34 (37.0)	36 (45.0)	3 (14.3)
Other	3 (3.3)	3 (3.7)	1 (4.7)
Disease duration [IQR]	11 [5–21]	10 [4.5–17.5]	5 [4–7]	0.01*
Time before treatment initiation [IQR]	4 [2–8]	3 [1–5]	2 [1–4]	0.003*
Injection frequency, n (%)
1/week (Etanercept)	46 (50.0)	48 (60.0)	14 (66.7)	0.03*
1/15 days (Adalimumab, Certolizumab)	42 (45.7)	22 (27.5)	4 (19.0)
1/month (Golimumab)	4 (4.3)	10 (12.5)	3 (14.3)

Note: *p-value <0.05.

Abbreviations: SD, standard deviation; RA, rheumatoid arthritis; AS, ankylosing spondyloarthritis; IQR, interquartile range.

Figure 1 Morisky Medication Adherence Scale (MMAS-4) scoring for the three therapeutic patient education models (models 1–3). MMAS-4 scores are color-coded; adherence was categorized as follows: MMAS=1: poor; MMAS=2 or 3: moderate; MMAS=4: good.

Notes: Adapted with permission from Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24:67–74.¹⁷ Use of the MMAS is protected by US and International copyright and Trademark laws. Permission for use is required. A license agreement is available from Donald E. Morisky, MMAS Research (MORISKY), 294 Lindura Court, Las Vegas, NV 89138-4632 [email protected].

Table 2 Anti-TNF Adherence According to Patient Characteristics

	Poor Adherence N = 13	Moderate Adherence N = 34	Good Adherence N = 146	p-value
Gender, n (%)
Female	11 (8.9)	18 (14.5)	95 (76.6)	0.12
Male	2 (2.9)	16 (23.2)	51 (73.9)
Age, mean ± SD	50.5 ± 16.7	45.9 ± 15.2	55.3 ± 14.0	0.005*
Education, n (%)
Elementary school	1 (6.3)	1 (6.3)	14 (87.4)	0.11
Middle school	3 (7.1)	4 (9.5)	35 (83.4)
High school	2 (2.6)	15 (19.5)	30 (77.9)
University	7 (13.0)	12 (22.2)	35 (64.8)
Socio-professional status, n (%)
Employed	8 (8.3)	19 (19.8)	69 (71.9)	0.33
Retired	4 (6.4)	7 (11.1)	52 (82.5)
Unemployed	1 (3.3)	8 (26.7)	21 (70.0)
Marital status, n (%)
Married/Civil union	9 (7.3)	19 (15.3)	96 (77.4)	0.23
Single	0 (0.0)	10 (23.3)	33 (76.7)
Widowed	1 (8.3)	1 (8.3)	10 (83.4)
Type of care, n (%)
Mixed	8 (7.6)	21 (20.0)	76 (72.4)	0.32
In-hospital	3 (3.6)	13 (15.4)	68 (81.0)
Pathologies, n (%)
RA	11 (9.7)	16 (14.2)	86 (76.1)	0.20
AS	2 (2.7)	17 (23.3)	54 (74.0)
Other	0 (0.0)	1 (1.3)	6 (85.7)
Median disease duration [IQR]	8 [7; 18]	8 [3; 17]	11 [5; 19]	0.49
Median time before treatment initiation [IQR]	4 [2; 7]	3 [2; 6]	3 [1; 6]	0.61
Injection frequency, n (%)
1/week (Etanercept)	9 (8.3)	18 (16.7)	81 (75.0)	0.89
1/15 days (Adalimumab, Certolizumab)	4 (5.9)	13 (19.1)	51 (75.0)
1/month (Golimumab)	0 (0.0)	3 (17.7)	14 (82.3)
BIOSECURE score, mean ± SD	75.6 ± 18.0	77.1 ± 10.7	75.7 ± 13.4	0.91

Note: *p-value<0.05.

Abbreviations: SD, standard deviation; RA, rheumatoid arthritis; AS, ankylosing spondyloarthritis; IQR, interquartile range.

Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24:67–74. doi:10.1097/00005650-198601000-00007

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