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. 2021 May 25:15:1107-1119.
doi: 10.2147/PPA.S297170. eCollection 2021.

Electronic Monitoring Feedback for Improving Medication Adherence and Clinical Outcomes in Early Rheumatoid Arthritis: A Randomized Clinical Trial

Milou van Heuckelum  1   2 , Cornelia H M van den Ende  1   3 , Sandra van Dulmen  4   5   6 , Bart J F van den Bemt  2   7   8
Affiliations

Electronic Monitoring Feedback for Improving Medication Adherence and Clinical Outcomes in Early Rheumatoid Arthritis: A Randomized Clinical Trial

Milou van Heuckelum et al. Patient Prefer Adherence. .

Abstract

Background: Non-adherence to medication (range 30-107%) is a major issue in patients with rheumatoid arthritis (RA). Previous research has shown that electronic monitoring feedback (EMF) might be an effective strategy to improve medication adherence in chronic conditions. Therefore, this study investigated the effectiveness of electronic monitoring feedback in patients with early RA to improve medication adherence and clinical outcomes compared to usual care.

Methods: An open-label randomized clinical trial was performed to compare EMF with standard care during a 12-month follow-up period on two sites of the Sint Maartenskliniek (Nijmegen and Boxmeer) in the Netherlands. Patients were eligible if they: (1) had a (working) diagnosis of early RA, (2) were currently using methotrexate, (3) were aged ≥18 years, and (4) had a life expectancy of ≥12 months. Primary outcome was the difference in proportion of non-adherent patients measured with the Compliance Questionnaire on Rheumatology after 12 months. Secondary outcomes were beliefs about medicines, medication adherence measured with the MMAS-8®, patients' health status, prescription of biologic DMARDs, and disease activity after 12 months.

Results: Of the 367 initially-invited patients, 93 patients with early RA agreed to participate in this study. No significant difference was found in the proportion of non-adherent patients between the intervention arm and the usual care arm after 12 months follow-up (60.0% and 61.3%, p=0.93, respectively). Patients in the intervention arm tended to discontinue methotrexate earlier than patients in the usual care arm (median time in weeks: 15.7 (9.1-33.6) and 21.9 (19-28.4), respectively, p=0.31), whereas patients in the usual care arm tended to initiate biologic DMARDs earlier than those in the intervention arm (median time in weeks: 11.9 (5.7-22) and 17 (9.9-40.9), respectively, p=0.55).

Conclusion: This study illustrates the challenge of targeting non-adherence with EMF in patients with early RA and shares important lessons learned about designing adherence intervention trials with respect to study attrition, accounting for drug survival, intervention fidelity, intervention uptake, and technical aspects.

Keywords: DMARDs; clinical outcomes; disease activity; medication adherence; randomized clinical trial; rheumatoid arthritis.

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Conflict of interest statement

Dr Milou van Heuckelum reports receipt of grants from the Dutch Arthritis Foundation during the conduct of the study and grants from the Dutch Arthritis Foundation outside the submitted work. The authors reported no other potential conflicts of interest in this work.

Figures

Figure 1
Figure 1
Study design of the RCT: electronic monitoring feedback (EMF) versus usual care.
Figure 2
Figure 2
Flowchart of study participants.
Figure 3
Figure 3
Kaplan–Meier survival estimates: discontinuation of methotrexate in both study arms.
Figure 4
Figure 4
Kaplan–Meier survival estimates: initiation of bDMARDs in both study arms.
See this image and copyright information in PMC

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References

    1. Smolen JS, Landewé R, Bijlsma J, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017;76:960–977. doi:10.1136/annrheumdis-2016-210715 - DOI - PubMed
    1. Waimann C, Marengo M, Achaval de S, et al. Electronic monitoring of oral therapies in ethnically diverse and economically disadvantaged patients with rheumatoid arthritis. Consequences of low adherence. Arthritis Rheum. 2013;65:1421–1429. doi:10.1002/art.37917 - DOI - PMC - PubMed
    1. Salt E, Frazier S. Adherence to disease modifying anti-rheumatic drugs in rheumatoid arthritis patients: a narrative review of the literature. Orthop Nurs. 2010;29:260–275. doi:10.1097/NOR.0b013e3181e5c2c9 - DOI - PMC - PubMed
    1. Pasma A, den Boer E, van ’T Spijker A, et al. Nonadherence to disease modifying antirheumatic drugs in the first year after diagnosis: comparing three adherence measures in early arthritis patients. Rheumatology. 2016;55(10):1812–1819. doi:10.1093/rheumatology/kew247 - DOI - PubMed
    1. Michaud K, Vrijens B, Tousset E, et al. Real‐world adherence to oral methotrexate measured electronically in patients with established rheumatoid arthritis. ACR Open Rheumatol. 2019;1:560–570. doi:10.1002/acr2.11079 - DOI - PMC - PubMed

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