Waimann Christian A, Marengo Maria F, de Achaval Sofia, Cox Vanessa L, Garcia-Gonzalez Araceli, Reveille John D, Richardson Marsha N, Suarez-Almazor Maria E
University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Arthritis Rheum. 2013 Jun;65(6):1421-9. doi: 10.1002/art.37917.
To quantify adherence to oral therapies in ethnically diverse and economically disadvantaged patients with rheumatoid arthritis (RA), using electronic medication monitoring, and to evaluate the clinical consequences of low adherence.
A total of 107 patients with RA enrolled in a 2-year prospective cohort study agreed to have their oral RA drug therapy intake electronically monitored using the Medication Event Monitoring System. Adherence to disease-modifying antirheumatic drugs (DMARDs) and prednisone was determined as the percentage of days (or weeks for methotrexate) on which the patient took the correct dose as prescribed by the physician. Patient outcomes were assessed, including function measured by the modified Health Assessment Questionnaire, disease activity measured by the Disease Activity Score in 28 joints (DAS28), health-related quality of life, and radiographic damage measured using the modified Sharp/van der Heijde scoring method.
Adherence to the treatment regimen as determined by the percentage of correct doses was 64% for DMARDs and 70% for prednisone. Patients who had better mental health were statistically more likely to be adherent. Only 23 of the patients (21%) had an average adherence to DMARDs ≥80%. These patients showed significantly better mean DAS28 values across 2 years of followup than those who were less adherent (3.28 versus 4.09; P = 0.02). Radiographic scores were also worse in nonadherent patients at baseline and at 12 months.
Only one-fifth of RA patients had an overall adherence to DMARDs of at least 80%. Less than two-thirds of the prescribed DMARD doses were correctly taken. Adherent patients had lower disease activity across the 2 years of followup.
使用电子药物监测来量化不同种族和经济条件不利的类风湿关节炎（RA）患者对口服治疗的依从性，并评估低依从性的临床后果。
共有107名参加为期2年前瞻性队列研究的RA患者同意使用药物事件监测系统对其口服RA药物治疗的摄入量进行电子监测。对改善病情抗风湿药（DMARDs）和泼尼松的依从性通过患者按医生规定服用正确剂量的天数（或甲氨蝶呤的周数）的百分比来确定。评估患者的结局，包括用改良健康评估问卷测量的功能、用28个关节疾病活动评分（DAS28）测量的疾病活动度、健康相关生活质量以及用改良Sharp/van der Heijde评分方法测量的影像学损伤。
根据正确剂量百分比确定的治疗方案依从性，DMARDs为64%，泼尼松为70%。心理健康状况较好的患者在统计学上更有可能坚持治疗。只有23名患者（21%）对DMARDs的平均依从性≥80%。在2年的随访中，这些患者的平均DAS28值明显优于依从性较差的患者（3.28对4.09；P = 0.02）。在基线和12个月时，不依从患者的影像学评分也更差。
只有五分之一的RA患者对DMARDs的总体依从性至少为80%。不到三分之二的规定DMARD剂量被正确服用。在2年的随访中，依从性好的患者疾病活动度较低。
