Virginia Pascual-Ramos
Arthritis Research & Therapy 2009, 11:R26doi:10.1186/ar2620
| Published: | 19 February 2009 |
Aggressive treatment with disease-modifying anti-rheumatic drugs (DMARDs) plays a major role in improving early rheumatoid arthritis (ERA) patient outcomes. Persistence and adherence with medication occurs variably (20-70%). The objectives of the study were: 1. To determine medication persistence (MP) in ERA patients over 13 consecutive two-month-apart visits. 2. To investigate the relationship between MP and disease activity, disability and structural damage. 3. To identify baseline prognosticators.
Charts from 75 patients of an ERA cohort were reviewed. At each visit, a rheumatologist interviewed patients regarding therapy, scored disease activity with the 28-joints disease activity score (DAS28) and disability with the health assessment questionnaire (HAQ) and recorded comorbidities and treatment. At baseline a complete medical history was obtained. MP was defined as the duration of time from initiation to discontinuation of at least one DMARD and/or corticosteroids for at least one week and was reported as a dichotomous variable at consecutive evaluations. Structural damage was defined by detection of new erosions on radiography. Descriptive statistics, Student's t and chi-squared tests and logistic regression analyses were used.
MP patients (MPP) decreased from 98% at two months to 34% at two years. MPP (N = 32) had similar DAS28 to non-MPP (N = 53) at initial visits, lower DAS28 and greater DAS28 improvements at follow-ups (p [less than or equal to]0.05 at visits 4, 6, 7 and 9) and reached sustained remission ([greater than or equal to]3 consecutive visits with DAS28 <2.6) more frequently (82.8% versus 46.5%, p = 0.003) and sooner (7.7 +/- 4.6 versus 13.6 +/- 5.7 months, p = 0.001) than non-MPP. MPP had similar baseline HAQs, but lower HAQs at follow-ups (p [less than or equal to]0.05 at visits 3, 5, 6, 7, 9, 10 and 13). More non-MPP developed erosive disease than MPP: 26.8% versus 17.9%, p = 0.56. Older age at baseline was associated with therapy discontinuation, OR: 1.1, 95% confidence interval (CI): 1.007 - 1.103, p = 0.02.
Discontinuation of DMARDs was frequent and progressive in an ERA cohort. Patients with persistence on therapy were younger, had lower disease activity and disability during follow-up and reached sustained remission more frequently and sooner than patients without it. MP should intentionally be evaluated during follow-up of ERA patients, as it seems to play a major role in outcome.