University Tunis El Manar, rheumatology department, Mongi Slim hospital, Sidi Daoued, 2046 La Marsa, Tunisia.
University Tunis El Manar, rheumatology department, Mongi Slim hospital, Sidi Daoued, 2046 La Marsa, Tunisia.
Therapie. 2021 Sep-Oct;76(5):467-474. doi: 10.1016/j.therap.2020.08.003. Epub 2020 Sep 2.
The emergence of biologics has revolutionized the management of refractory rheumatic diseases (RD) by improving clinical outcomes. Unfortunately, the impact of non-adherence to the emerging therapy can limit their potential benefit. The objective of our study was to evaluate biologics' adherence in Tunisian patients with RD and to assess the determinants of non-adherence.
We conducted a cross-sectional study involving patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) treated with bDMARDs (biologic disease-modifying antirheumatic drugs) for at least three months. Socio-demographic, clinical and biological data were collected. Biologic adherence was assessed using the compliance questionnaire for rheumatology (CQR).
One hundred patients with RD (45 RA and 55 SpA) were collected. Non-adherence to bDMARDs was found in 70% of cases. In univariate analysis, non-adherence to bDMARDs was statistically related to the absence of coxitis (P=0.003), to a low ASDAS-CRP (ankylosing spondylitis disease activity score) prior to the initiation of the bDMARDs (P=0.01), to a rate of administration of bDMARDs less than one injection per month (P=0.01), to the subcutaneous delivery route (P=0.02) as well as to non-adherence to csDMARDs (conventional disease-modifying antirheumatic drugs) (P=0.001). In multivariate analysis, the predictors of non-adherence were the absence of coxitis (OR=6.01; IC 95% [1.88-19.12]; P=0.002], and a rate of administration of bDMARDs less than one injection per month (OR=8.79; IC 95% [2.13-36.22]; P=0.003).
This work has revealed the low rate of adherence to biological treatments in Tunisian patient with RD. Predictors of poor adherence were the absence of coxitis and a rate of administration of bDMARDs less than one injection per month. Detection of these factors could help us to adapt our strategies to improve adherence that are essentially based on therapeutic education program.
生物制剂的出现通过改善临床结果，彻底改变了难治性风湿性疾病（RD）的治疗方法。不幸的是，不遵守新兴疗法可能会限制其潜在益处。我们研究的目的是评估突尼斯 RD 患者对生物制剂的依从性，并评估不依从的决定因素。
我们进行了一项横断面研究，纳入了至少接受了三个月 bDMARD（生物改善疾病抗风湿药物）治疗的类风湿关节炎（RA）和脊柱关节炎（SpA）患者。收集了社会人口统计学、临床和生物学数据。使用风湿病依从性问卷（CQR）评估生物制剂的依从性。
共收集了 100 例 RD 患者（45 例 RA 和 55 例 SpA）。发现 70%的患者不依从 bDMARD。单因素分析显示，不依从 bDMARD 与coxitis 缺失（P=0.003）、bDMARD 治疗前低 ASDAS-CRP（强直性脊柱炎疾病活动评分）（P=0.01）、bDMARD 给药频率低于每月一次（P=0.01）、皮下给药途径（P=0.02）以及不依从 csDMARD（常规改善疾病的抗风湿药物）（P=0.001）有关。多因素分析显示，不依从的预测因素为coxitis 缺失（OR=6.01；95%CI[1.88-19.12]；P=0.002）和 bDMARD 给药频率低于每月一次（OR=8.79；95%CI[2.13-36.22]；P=0.003）。
这项工作揭示了突尼斯 RD 患者对生物治疗的依从性低。不依从的预测因素是coxitis 缺失和 bDMARD 给药频率低于每月一次。发现这些因素有助于我们调整策略以提高依从性，这主要基于治疗教育计划。
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