Influence of route of administration/drug formulation and other factors on adherence to treatment in rheumatoid arthritis (pain related) and dyslipidemia (non-pain related)

Abstract

Objectives: A comprehensive review was performed to investigate the effect of route of administration on medication adherence and persistence in rheumatoid arthritis (RA) and to compare adherence/persistence with oral medications between RA and a non-painful disease (dyslipidemia).

Research design and methods: Comprehensive database searches were performed to identify studies investigating medication adherence and/or persistence in adults with RA receiving conventional synthetic or biologic agents. Similar searches were performed for studies of patients with dyslipidemia receiving statins. Studies had to be published after 1998 in English and involve ≥6 months’ follow up.

Main outcome measures: Adherence and persistence were compared between the different routes of drug administration in RA, and between the two diseases for oral medications.

Results: A total of 35 and 28 papers underwent data extraction for RA and dyslipidemia, respectively. Within the constraints of the analysis, adherence and persistence rates appeared broadly similar for the different routes of drug administration in RA. Adherence to oral medications was also broadly similar across the two diseases, but persistence was lower in dyslipidemia. Poor adherence has clinical consequences in both diseases: greater disease activity and risk of flare in RA, and increased serum cholesterol levels and risk of heart and cerebrovascular disease in dyslipidemia. Over 1–3 years, poor adherence to biologic RA medications led to increased resource use and medical costs but lower total direct costs due to reduced biologic drug costs. Conversely, poor adherence to dyslipidemia medications resulted in increased total direct costs. In both diseases, adherence improved with patient education/support.

Conclusions: The route of drug administration and the symptomatic (pain) nature of the disease do not appear to be dominant factors for drug adherence or persistence in RA.

Limitation: The wide range of adherence and persistence values and definitions across studies made comparisons between drug formulations and diseases difficult.

Keywords:

• Drug formulation
• dyslipidemias
• patient adherence
• rheumatoid arthritis

Transparency

Declaration of funding

This work was sponsored by Eli Lilly and Company.

Declaration of financial/other relationships

B.F. has received fees from AbbVie, Biogen, BMS, Celgene, Hospira, Janssen, Eli Lilly, MSD, NORDIC Pharma, Pfizer, Roche, SOBI, UCB, and unrestricted research grants from AbbVie, MSD, and Pfizer.

M.C., J.-P.C., C.C. and I.d.l.T. have disclosed that they are employees of Eli Lilly and Company. A.B. has disclosed that he has received grants from Pfizer, Novartis, and Abbvie, and personal fees from Eli Lilly, Pfizer, Abbvie, Roche, UCB, Novartis and BMS. P.v.R. has disclosed that he has received grants from Abbott, BMS, MSD, Roche and UCB, and personal fees from Abbott, BMS, MSD, Pfizer, Roche, Eli Lilly and UCB.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Previous presentation: Some of the data contained in this paper were presented in a poster at the European League Against Rheumatism (EULAR) Annual Congress, London, 8–11 June 2016.

Acknowledgments

The authors would like to acknowledge Dr Sue Chambers and David Peters (Rx Communications, Mold, UK) for medical writing assistance with the preparation of this manuscript, funded by Eli Lilly and Company.