Curtis Jeffrey R, Bharat Aseem, Chen Lang, Greenberg Jeffrey D, Harrold Leslie, Kremer Joel M, Sommers Tanya, Pappas Dimitrios
From the University of Alabama at Birmingham, Birmingham, Alabama; Consortium of Rheumatology Researchers of North America (CORRONA) LLC, Southborough; University of Massachusetts, Worcester, Massachusetts, USA.J.R. Curtis, MD, MS, MPH, University of Alabama at Birmingham; A. Bharat, MD, MPH, University of Alabama at Birmingham; L. Chen, PhD, University of Alabama at Birmingham; J.D. Greenberg, MD, MPH, CORRONA LLC; L. Harrold, MD, MPH, University of Massachusetts; J.M. Kremer, MD, CORRONA LLC; T. Sommers, MS, CORRONA LLC; D. Pappas, MD, MPH, CORRONA LLC.
J Rheumatol. 2016 Jun;43(6):1027-9. doi: 10.3899/jrheum.151136. Epub 2016 May 1.
Rheumatologists have limited tools to assess medication adherence. The extent to which methotrexate (MTX) adherence is overestimated by rheumatologists is unknown.
We deployed an Internet survey to patients with rheumatoid arthritis (RA) participating in a US registry. Patient self-report was the gold standard compared to MTX recorded in the registry.
Response rate to the survey was 44%. Of 228 patients whose rheumatologist reported current MTX at the time of the most recent registry visit, 45 (19.7%) had discontinued (n = 19, 8.3%) or missed ≥ 1 dose in the last month (n = 26, 11.4%). For the subgroup whose rheumatologist also confirmed at the next visit that they were still taking MTX (n = 149), only 2.6% reported not taking it, and 10.7% had missed at least 1 dose.
MTX use was misclassified for 13%-20% of patients, mainly because of 1 or more missed doses rather than overt discontinuation. Clinicians should be aware of suboptimal adherence when assessing MTX response.
风湿病学家评估药物依从性的工具有限。目前尚不清楚风湿病学家对甲氨蝶呤（MTX）依从性的高估程度。
我们对参与美国一项登记研究的类风湿关节炎（RA）患者进行了一项网络调查。与登记研究中记录的MTX情况相比，患者的自我报告被视为金标准。
调查的回复率为44%。在228例其风湿病学家报告在最近一次登记访视时正在使用MTX的患者中，45例（19.7%）已停药（n = 19，8.3%）或在上个月漏服≥1剂（n = 26，11.4%）。对于其风湿病学家在下一次访视时也确认仍在服用MTX的亚组患者（n = 149），只有2.6%报告未服用，10.7%至少漏服了1剂。
13%-20%的患者MTX使用情况被错误分类，主要原因是漏服1剂或多剂而非明显停药。临床医生在评估MTX疗效时应注意依从性欠佳的情况。
