Horne Rob, Albert Adelin, Boone Caroline
University College London School of Pharmacy, London, UK.
Biostatistics, University Hospital of Liège, Liège, Belgium.
Patient Prefer Adherence. 2018 Jun 22;12:1099-1111. doi: 10.2147/PPA.S166451. eCollection 2018.
In patients with rheumatoid arthritis (RA), nonadherence to treatment is often related to patients' beliefs and concerns regarding their medication. This study aimed to analyze the correlations regarding patients' medication beliefs, medication adherence, and objective measures of disease activity and safety in patients with RA established on subcutaneous (SC) anti-tumor necrosis factor α (TNFα) therapy.
This Phase IV, noninterventional, non-drug-specific study enrolled patients with RA being treated with stable-dose SC anti-TNFα (adalimumab, etanercept, golimumab, and certolizumab pegol). At initial visit and 6 and 12 months later, patients completed the Beliefs about Medicines Questionnaire-Specific section, assessing perceptions of personal need for anti-TNFα therapy (anti-TNFα-Necessity) and concerns (anti-TNFα-Concerns), Medication Adherence Rating Scale (MARS), mean Disease Activity Score in 28 joints (DAS28), and other scales. Longitudinal data were analyzed by linear mixed models.
A total of 460 patients were included. At initial visit, anti-TNFα-Necessity beliefs were high (mean ± SD: 4.3 ± 0.55) vs anti-TNFα-Concerns (2.8 ± 0.78). Medication adherence (MARS) was high (4.8 ± 0.39). All scores remained stable over the 1-year follow-up period. Anti-TNFα-Necessity beliefs and anti-TNFα-Concerns were not related to each other, but strongly correlated with medication adherence. While concerns worsened with disease activity, clinical status, and low quality of life, necessity beliefs remained unaffected.
In patients with RA established on stable-dose SC anti-TNFα, anti-TNFα-Necessity beliefs persistently outweighed anti-TNFα-Concerns, but both correlated with adherence. These findings may be of use in subsequent studies looking to predict adherence in patients starting treatment with SC anti-TNFα.
在类风湿关节炎（RA）患者中，治疗依从性不佳往往与患者对药物的信念和担忧有关。本研究旨在分析接受皮下注射（SC）抗肿瘤坏死因子α（TNFα）治疗的RA患者的药物信念、药物依从性与疾病活动和安全性客观指标之间的相关性。
这项IV期、非干预性、非药物特异性研究纳入了正在接受稳定剂量SC抗TNFα（阿达木单抗、依那西普、戈利木单抗和聚乙二醇化赛妥珠单抗）治疗的RA患者。在初次就诊时以及6个月和12个月后，患者完成了《药物信念问卷》特定部分，评估对抗TNFα治疗的个人需求感知（抗TNFα必要性）和担忧（抗TNFα担忧）、药物依从性评定量表（MARS）、28个关节的平均疾病活动评分（DAS28）以及其他量表。纵向数据采用线性混合模型进行分析。
共纳入460例患者。在初次就诊时，抗TNFα必要性信念较高（均值±标准差：4.3±0.55），而抗TNFα担忧较低（2.8±0.78）。药物依从性（MARS）较高（4.8±0.39）。在1年的随访期内，所有评分均保持稳定。抗TNFα必要性信念和抗TNFα担忧彼此不相关，但与药物依从性密切相关。虽然担忧随着疾病活动、临床状况和生活质量低下而加剧，但必要性信念不受影响。
在接受稳定剂量SC抗TNFα治疗的RA患者中，抗TNFα必要性信念一直高于抗TNFα担忧，但两者均与依从性相关。这些发现可能有助于后续研究预测开始接受SC抗TNFα治疗的患者的依从性。
