Few Taking DMARDs Correctly, Study Finds

Participants in a new study of people prescribed oral disease-modifying antirheumatic drugs (DMARDs) to treat their rheumatoid arthritis (RA) took less than two-thirds of their doses correctly and, according to researchers, this low adherence was linked to worse outcomes. Even with the advent of powerful “biologic” drugs, methotrexate (brand name Rheumatrex) remains the standard first treatment for people with RA, and most biologics are prescribed in combination with methotrexate and/or other oral DMARDs. Adherence to these drugs, however, is often less than perfect and researchers found that few people who participated in the study were taking DMARDs correctly.

Researchers in Texas recently followed a little over 100 people with RA for two years to see how well they stuck to their treatment regimens. Study participants took either oral DMARDs, such as methotrexate; steroids, such as prednisone (Prednisolone); or both.

There has already been a fair amount of research into whether people with arthritis actually take the drugs they are prescribed, but many such studies have used interviews, diaries, or data from pharmacies, all of which can be unreliable. In the hopes of getting a more accurate picture of treatment adherence, the researchers in this new study — published in a 2013 issue of Arthritis and Rheumatism — used high-tech pill bottles that electronically recorded every time they were opened to track when people took their medicines with better certainty.

In addition to adherence, the researchers followed the participants’ disease progression over the two-year study period and also looked at various demographic details, such as the participants’ ethnicity, income, education level, and insurance status.

More than 80% of people in the study were prescribed methotrexate. The majority of participants were also taking biologics in addition to an oral DMARD or steroid, and nearly one-fifth of participants were taking three DMARDs or more.

At the end of the two years, the researchers found that only a little over 20% of the people in the study took the DMARDs they were prescribed as prescribed at least 80% of the time, with participants taking fewer doses than they were prescribed as much as 40% of the time, depending on the drug. Some participants also took more doses than they were prescribed, but this was less common.

Not surprisingly, those participants who had better adherence tended to have lower disease activity throughout the study. People with better adherence also tended to have less radiographic damage and better function.

The researchers found that people with better mental health and people who were either married or had a significant other were more likely to take their medicines as prescribed.

The study authors also found that people whose arthritis was less active at the start of the study generally had better adherence during the study. Although this finding could be taken as an indication that it is easier for people with less active arthritis to stick to their treatment regimens, the study authors suggest instead that this finding demonstrates the benefits of long-term adherence from before the study began.

This is only a small study, however, and there are many limitations. The study authors point out that participants in the study generally had low incomes, tended to be underinsured, and were more ethnically diverse than the overall population. Thus, they say, the results of the study “cannot be generalized to the population at large.”

However, the study’s findings still serve to emphasize how important it is for people with RA to stick to their treatment regimens so as to better manage their condition.

Cooper B. Wilhelm is an Assistant Editor at Arthritis Self-Management

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