Laure Gossec1, Anna Molto2, Xavier Romand3, Déborah Puyraimond-Zemmour4, Matthieu Lavielle2, Catherine Beauvais5, Eric Senbel6, René-Marc Flipo7, Sophie Pouplin8, Christophe Richez9, Alain Saraux10, Maryse Mézières2, Loriane Gutermann2, Philippe Gaudin3, Daniel Wendling11, Maxime Dougados2. 1. Sorbonne Université, 75013 Paris, France; Institut Pierre-Louis d'Épidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), 75013 Paris, France; Pitié-Salpêtrière hospital, AP-HP, Rheumatology department, 75013 Paris, France. Electronic address: laure.gossec@gmail.com. 2. Rheumatology Department, Cochin Hospital, AP-HP, 75014 Paris, France; Inserm Unit 1183 (CRESS), 75014 Paris, France. 3. Université Grenoble Alpes, GREPI EA7408, 38400 Saint-Martin-d'Hères, France; Grenoble Hospital, Department of Rheumatology, 38700 La Tronche, France. 4. Sorbonne Université, 75013 Paris, France; Institut Pierre-Louis d'Épidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), 75013 Paris, France; Pitié-Salpêtrière hospital, AP-HP, Rheumatology department, 75013 Paris, France. 5. Department of Rheumatology, AP-HP, Saint-Antoine Hospital, 75012 Paris, France. 6. Cabinet de rhumatologie, 24, place Castellane, 13006 Marseille, France. 7. Department of Rheumatology, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France. 8. Department of Rheumatology, Rouen Hospital, 76081 Rouen, France. 9. Department of Rheumatology, Pellegrin Hospital, 33000 Bordeaux, France; Bordeaux University, CNRS 5164, 33000 Bordeaux, France. 10. Department of Rheumatology, CHU de la Cavale-Blanche, boulevard Tanguy-Prigent, 29200 Brest, France; Inserm 1227, Université Bretagne Occidentale, 29200 Brest, France. 11. Department of Rheumatology, CHRU de Besançon, 25030 Besançon, France; EA 4266, Université de Franche-Comté, 25030 Besançon, France.
Abstract
BACKGROUND: Adherence to treatment is a key issue in chronic inflammatory rheumatic diseases (CIRDs). OBJECTIVE: To develop recommendations to facilitate in daily practice, the management of non-adherence to disease-modifying drugs in patients with rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, connective tissue diseases or other CIRDs. METHODS: The process comprised (a) systematic literature reviews of methods (including questionnaires) to measure non-adherence, risk factors for non-adherence and efficacy of targeted interventions; (b) development of recommendations through consensus of 104 rheumatologist and nurse experts; (c) assessment of agreement and ease of applicability (1-5 where 5 is highest) by the 104 experts. RESULTS: (a) Overall, 274 publications were analysed. (b) The consensus process led to 5 overarching principles and 10 recommendations regarding adherence. Key points include that adherence should be assessed at each outpatient visit, at least using an open question; questionnaires and hydroxychloroquine blood level assessments may also be useful. Risk factors associated to non-adherence were listed. Patient information and education, and patient/physician shared decision, are key to optimize adherence. Other techniques such as formalized education sessions, motivational interviewing and cognitive behavioral therapy may be useful. All health professionals can get involved and e-health may be a support. (c) The agreement with the recommendations was high (range of means, 3.9-4.5) but ease of applicability was lower (2.7-4.4). CONCLUSIONS: Using an evidence-based approach followed by expert consensus, this initiative should improve the assessment and optimization of adherence in chronic inflammatory rheumatic disorders.
BACKGROUND: Adherence to treatment is a key issue in chronic inflammatory rheumatic diseases (CIRDs). OBJECTIVE: To develop recommendations to facilitate in daily practice, the management of non-adherence to disease-modifying drugs in patients with rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, connective tissue diseases or other CIRDs. METHODS: The process comprised (a) systematic literature reviews of methods (including questionnaires) to measure non-adherence, risk factors for non-adherence and efficacy of targeted interventions; (b) development of recommendations through consensus of 104 rheumatologist and nurse experts; (c) assessment of agreement and ease of applicability (1-5 where 5 is highest) by the 104 experts. RESULTS: (a) Overall, 274 publications were analysed. (b) The consensus process led to 5 overarching principles and 10 recommendations regarding adherence. Key points include that adherence should be assessed at each outpatient visit, at least using an open question; questionnaires and hydroxychloroquine blood level assessments may also be useful. Risk factors associated to non-adherence were listed. Patient information and education, and patient/physician shared decision, are key to optimize adherence. Other techniques such as formalized education sessions, motivational interviewing and cognitive behavioral therapy may be useful. All health professionals can get involved and e-health may be a support. (c) The agreement with the recommendations was high (range of means, 3.9-4.5) but ease of applicability was lower (2.7-4.4). CONCLUSIONS: Using an evidence-based approach followed by expert consensus, this initiative should improve the assessment and optimization of adherence in chronic inflammatory rheumatic disorders.
Authors: György Nagy; Nadia M T Roodenrijs; Désirée van der Heijde; Jacob M van Laar; Paco M J Welsing; Melinda Kedves; Attila Hamar; Marlies C van der Goes; Alison Kent; Margot Bakkers; Polina Pchelnikova; Etienne Blaas; Ladislav Senolt; Zoltan Szekanecz; Ernest H Choy; Maxime Dougados; Johannes Wg Jacobs; Rinie Geenen; Johannes Wj Bijlsma; Angela Zink; Daniel Aletaha; Leonard Schoneveld; Piet van Riel; Sophie Dumas; Yeliz Prior; Elena Nikiphorou; Gianfranco Ferraccioli; Georg Schett; Kimme L Hyrich; Ulf Mueller-Ladner; Maya H Buch; Iain B McInnes Journal: Ann Rheum Dis Date: 2021-08-18 Impact factor: 19.103