THU0658 Recommendations for the assessment and optimisation of adherence to disease-modifying drugs in chronic inflammatory rheumatic diseases: a process based on literature reviews and consensus
Authors: L. Gossec, A. Molto, X. Romand, D. Puyraimond-Zemmour, M. Lavielle, C. Beauvais, E. Senbel, R.-M. Flipo, S. Pouplin, C. Richez, A. Saraux, L. Gutermann, P. Gaudin, D. Wendling, M. Dougados
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> In chronic inflammatory rheumatic diseases including rheumatoid arthritis (RA), spondyloarthritis (SpA), psoriatic arthritis (PsA) and connective tissue diseases (CTD), adherence to disease-modifying drugs is only moderate over the long term and non-adherence may lead to complications, unnecessary treatment switches and heightened costs. <h3>Objectives</h3> To develop recommendations to facilitate in daily practice, the measurement of non-adherence, the individualised assessment of risk of non-adherence and the management of non-adherence with the objective to optimise adherence to treatments in patients with chronic inflammatory rheumatic diseases. <h3>Methods</h3> The project scope was limited to chronic inflammatory rheumatic diseases (i.e., RA, SpA, PsA, CTD, cristal-induced arthritis, vasculitis and auto-inflammatory diseases), and to disease-modifying drugs (i.e., mainly conventional DMARDs, biologics and targeted synthetic DMARDs). The process comprised (a) systematic literature reviews of data from 3 key databases and several websites, of methods (including questionnaires) to measure non-adherence, risk factors for non-adherence and management options for non-adherence with their reported efficacy. (b) a consensus of 104 rheumatologist and nurse experts during a 2 day face-to-face meeting. (c) Final recommendations were anonymously evaluated by the participants for agreement and ease of applicability (1–5 were 5 is highest). <h3>Results</h3> (a) After screening 1131 publications and 194 other documents, 231 relevant papers were analysed. (b) The consensus process led to 5 overarching principles and 10 recommendations regarding adherence. In summary, adherence is important, imperfect, and multi-factorial. Patient-physician interactions play an important role, as do patient beliefs. Adherence should be assessed at each outpatient visit, at least using an open question. Questionnaires and hydroxychloroquine blood level assessments may also be useful. People who are younger, worried of side effects, do not see the necessity of the treatment, and are in psychological distress are more prone to non-adherence. Patient information and education, and patient/physician shared decision, are key to optimise adherence. Other techniques such as formalised education sessions, motivational interviewing and cognitive behavioural 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, 3.88–4.47) but ease of applicability was lower (2.69–4.38). <h3>Conclusions</h3> Using an evidence-based approach followed by expert consensus, this initiative should improve the assessment and optimisation of adherence in chronic inflammatory rheumatic disorders. Next steps include dissemination and implementation. <h3>Acknowledgements</h3> AbbVie France funded this initiative but played no role in the recommendations. <h3>Disclosure of Interest</h3> None declared