Fautrel Bruno, Balsa Alejandro, Van Riel Piet, Casillas Marta, Capron Jean-Philippe, Cueille Carine, de la Torre Inmaculada
a Pierre et Marie Curie University, Sorbonne Universités ; and Rheumatology Department, Pitié Salpêtrière Hospital , Paris , France.
b Rheumatology Department and Health Research Institute (Idipaz) , Hospital Universitario de La Paz , Madrid , Spain.
Curr Med Res Opin. 2017 Jul;33(7):1231-1246. doi: 10.1080/03007995.2017.1313209. Epub 2017 Apr 28.
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).
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.
Adherence and persistence were compared between the different routes of drug administration in RA, and between the two diseases for oral medications.
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.
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.
The wide range of adherence and persistence values and definitions across studies made comparisons between drug formulations and diseases difficult.
进行一项全面综述，以研究给药途径对类风湿关节炎（RA）患者药物依从性和持续性的影响，并比较RA患者与非疼痛性疾病（血脂异常）患者口服药物的依从性/持续性。
进行全面的数据库检索，以识别调查接受传统合成或生物制剂治疗的成年RA患者药物依从性和/或持续性的研究。对接受他汀类药物治疗的血脂异常患者的研究进行了类似检索。研究必须于1998年后以英文发表且随访时间≥6个月。
比较RA中不同给药途径之间以及两种疾病口服药物之间的依从性和持续性。
分别有35篇和28篇论文被提取用于RA和血脂异常的数据。在分析的限制范围内，RA中不同给药途径的依从率和持续率大致相似。两种疾病口服药物的依从性也大致相似，但血脂异常患者的持续性较低。依从性差在两种疾病中均有临床后果：RA中疾病活动度更高和病情复发风险增加，血脂异常中血清胆固醇水平升高以及心血管和脑血管疾病风险增加。在1至3年期间，RA生物制剂药物依从性差导致资源使用和医疗成本增加，但由于生物药物成本降低，总直接成本较低。相反，血脂异常药物依从性差导致总直接成本增加。在两种疾病中，患者教育/支持可提高依从性。
给药途径和疾病的症状性（疼痛）本质似乎不是RA患者药物依从性或持续性的主导因素。
各研究中依从性和持续性值及定义范围广泛，使得药物制剂和疾病之间的比较变得困难。
