UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Pabellón C: "Hospital Civil", Plaza del Hospital Civil s/n, 29009, Málaga, Spain.
Hospitalary pharmacy, Hospital Regional Universitario de Málaga, Málaga, Spain.
Rheumatol Int. 2017 Oct;37(10):1709-1718. doi: 10.1007/s00296-017-3758-6. Epub 2017 Jun 19.
The aims of this study were to evaluate adherence of rheumatoid arthritis (RA) patients to biological disease-modifying antirheumatic drugs (bDMARDs), identify potential risk factors, and analyze the discriminative ability of the Morisky-Green test (MGT) to detect bDMARD nonadherence. One hundred and seventy-eight adult RA patients treated with bDMARDs were included. Adherence was measured using the medication possession ratio (MPR) of the previous 6 months. An MPR >80% was considered good adherence. Patient demographics, clinical characteristics, and MGT scores were assessed through a standardized clinical interview at the cross-sectional date. One-hundred and twelve patients (63%) were taking subcutaneous bDMARDs, while 66 (37%) were taking intravenous drugs. One-hundred fifty-eight (88.8%) showed good adherence to bDMARDs, while 79 (61.2%) also correctly took concomitant conventional synthetic DMARDs (csDMARDs). In logistic regression models, nonadherence to bDMARDs was associated with higher disease activity [odds ratio (OR) 1.45; 95% CI, 1.03-2.03; p = 0.032] and subcutaneous route (OR 3.70; 95% CI 1.02-13.48; p = 0.040). MGT accurately identified an MPR >80% of bDMARDs in 76.9% of the patients. A sensitivity of 78%, specificity of 70%, positive predictive value of 95.3%, negative predictive value of 28.5%, positive likelihood ratio (LR) of 2.6, and negative LR of 0.3% were obtained. Adherence may be good for bDMARDs but is low for csDMARDs. Low adherence for bDMARDs is associated with poorer disease control during the past 6 months and use of subcutaneous route. These findings should alert doctors to consider possible low adherence before declaring treatment failure.
本研究旨在评估类风湿关节炎（RA）患者对生物改善病情抗风湿药物（bDMARD）的依从性，识别潜在的风险因素，并分析 Morisky-Green 测试（MGT）对检测 bDMARD 不依从的区分能力。共纳入 178 例接受 bDMARD 治疗的成年 RA 患者。依从性通过前 6 个月的药物持有率（MPR）来衡量。MPR＞80%被认为是良好的依从性。在横断面研究中，通过标准化临床访谈评估患者的人口统计学特征、临床特征和 MGT 评分。112 例（63%）患者接受皮下 bDMARD 治疗，66 例（37%）患者接受静脉内药物治疗。158 例（88.8%）患者对 bDMARD 具有良好的依从性，同时 79 例（61.2%）患者也正确服用了伴随的常规合成改善病情抗风湿药（csDMARD）。在逻辑回归模型中，bDMARD 不依从与疾病活动度较高相关（优势比[OR] 1.45；95%置信区间[CI]，1.03-2.03；p=0.032）和皮下途径（OR 3.70；95% CI 1.02-13.48；p=0.040）。MGT 准确识别了 76.9%患者的 bDMARD 药物 MPR＞80%。MGT 对 bDMARD 药物的敏感性为 78%，特异性为 70%，阳性预测值为 95.3%，阴性预测值为 28.5%，阳性似然比（LR）为 2.6，阴性 LR 为 0.3%。bDMARD 的依从性可能较好，但 csDMARD 的依从性较低。过去 6 个月 bDMARD 低依从性与较差的疾病控制和皮下途径的使用有关。这些发现应提醒医生在宣布治疗失败之前考虑可能的低依从性。
