Senbel Eric, Tropé Sonia, Herman-Demars Hélène, Zinovieva Elena, Courbeyrette Agnès, Clerson Pierre, Fardini Yann, Flipo René-Marc
Rheumatology Office, Marseille, France.
French National Patient Organization Against Rheumatoid Arthritis (ANDAR), Montpellier, France.
Patient Prefer Adherence. 2021 Apr 14;15:751-760. doi: 10.2147/PPA.S301010. eCollection 2021.
The purpose of the APRIM study (for Adherence Polyarthrite Rhumatoïde Injection Methotrexate) was to investigate the change in treatment adherence of patients with rheumatic arthritis (RA) who switched from oral to subcutaneous methotrexate (MTX).
Prospective, observational study in RA patients treated with MTX and switching from oral to subcutaneous (SC) route in real-life conditions. Data on motivations for switch, disease activity (DAS28-CRP), quality of life (AISM-2 SF), disability (HAQ-DI), and adherence to MTX were collected at inclusion (M0) and 6 months later (M6). Adherence was assessed by the 8-item Morisky Medication Adherence Scale (MMAS-8) and defined as high (MMAS-8 = 8), medium (MMAS-8 = 6 or ≤8) or low (MMAS-8 < 6). The primary evaluation criterion was the proportion of patients who maintained strong adherence or improved adherence by at least one category (from low to medium or strong or from medium to strong) between M0 and M6.
The analysis involved 207 patients (age 60.4±12.7 years, 75.2% females). 6.7% were in remission and 15.5% had low disease activity (LDA) at baseline. 58.5% reached the primary criterion and strong adherence rate increased from 42.0% to 50.7%. Change of route was combined with increased MTX dose in 34.8% of patients. Switch to SC route increased the proportion of patients with remission or LDA from 22.8% to 52.9% and increased quality of life even in patients with unchanged MTX dose.
Overall, change from oral to SC route improved adherence to MTX, RA control and quality of life independently of change in MTX dose.
APRIM研究（类风湿关节炎甲氨蝶呤注射依从性研究）的目的是调查从口服甲氨蝶呤（MTX）转换为皮下注射MTX的类风湿关节炎（RA）患者的治疗依从性变化。
在现实生活条件下，对接受MTX治疗且从口服转换为皮下（SC）给药途径的RA患者进行前瞻性观察研究。在纳入研究时（M0）和6个月后（M6）收集关于转换原因、疾病活动度（DAS28-CRP）、生活质量（AISM-2 SF）、残疾程度（HAQ-DI）以及MTX依从性的数据。依从性通过8项Morisky药物依从性量表（MMAS-8）进行评估，并定义为高（MMAS-8 = 8）、中（MMAS-8 = 6或≤8）或低（MMAS-8 < 6）。主要评估标准是在M0和M6之间维持高依从性或依从性至少提高一个等级（从低到中或高或从中到高）的患者比例。
分析涉及207例患者（年龄60.4±12.7岁，75.2%为女性）。基线时6.7%处于缓解期，15.5%疾病活动度低（LDA）。58.5%达到主要标准，高依从率从42.0%增至50.7%。34.8%的患者转换给药途径的同时增加了MTX剂量。转换为SC给药途径使缓解期或LDA患者的比例从22.8%增至52.9%，即使MTX剂量不变，生活质量也有所提高。
总体而言，从口服转换为SC给药途径可提高对MTX的依从性、改善RA控制情况及生活质量，且与MTX剂量变化无关。
