SAT0095 MEDICATION NECESSITY AND CONCERN BELIEFS ARE DISTINCT, INTERACTIVE PREDICTORS OF TREATMENT ADHERENCE IN RHEUMATOID ARTHRITIS
Authors: George Karpouzas, Elizabeth Hernandez, Vibeke Strand, Sarah Ormseth
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Medication adherence is instrumental for the successful management of rheumatoid arthritis (RA) to a goal of remission. Awareness of medication necessity and concerns regarding its use influence adherence and respectively foster or undermine the achievement of treatment goals. <h3>Objectives</h3> We explored the unique and interactive roles of patient beliefs about the necessity of RA medications and concerns about them in predicting adherence to prescribed treatments. <h3>Methods</h3> We evaluated 316 patients with established RA from a single center. Beliefs about the necessity of RA medications and concerns regarding their use were evaluated with the Beliefs about Medicines Questionnaire-Specific (BMQ) Necessity and Concerns scales (range 5-25). Self-reported rheumatoid arthritis treatment adherence was assessed using the Simplified Medication Adherence Questionnaire (SMAQ, range 0-6). Multivariable linear regression evaluated the effects of necessity, concerns and their interactions with adherence. A latent profile analysis (LPA) subsequently classified patients in groups according to patterns of necessity and concerns; adherence scores were then compared across latent groups using ANCOVA. <h3>Results</h3> Full adherence (SMAQ score 6/6) was reported by 101 (32%) patients. Necessity and concerns had independent and opposing contributions to adherence (β=0.21 and β=-0.28 respectively, p&lt;0.001 and figure 1a) even after adjustments for age, gender and disease duration. An interaction between necessity and concerns with adherence was also observed (p=0.009); post-hoc simple-slope tests showed that necessity predicted adherence with increasing concerns. Johnson-Neyman technique revealed that while concerns were significantly associated with adherence across the entire range of necessity scores, necessity was significantly related to adherence only at BMQ Concerns scores ≥13. LPA revealed four latent patient groups: Low necessity/Low concerns (indifferent, n=33), Low necessity/High concerns (skeptical, n=70), High necessity/High concerns (ambivalent, n=92) and High necessity/Low concerns (accepting, n=121). Adherence varied across groups even after adjusting for between-group differences (p=0.002, Figure 1b); adherence was highest in the accepting group and lowest in the skeptical group. <h3>Conclusion</h3> The relationship between necessity and concern beliefs regarding RA medications significantly influences adherence behavior and may further direct physicians to effectively target their education efforts. A message aimed at reducing concerns might be more effective in the ambivalent subgroup, whereas emphasizing medication necessity may be more fruitful in the skeptical group. <h3>Disclosure of Interests</h3> George Karpouzas Grant/research support from: Pfizer, Consultant for: Sanofi-Genzyme-Regeneron, Janssen, Roche-Genentech, Pfizer, Speakers bureau: BMS, Sanofi-Genzyme-Regeneron, Janssen, Roche-Genentech, Elizabeth Hernandez: None declared, Vibeke Strand Consultant for: AbbVie, Amgen, Bayer, BMS, Boehringer Ingelheim, Celgene, Celltrion, CORRONA, Crescendo, EMD Serono, Genentech/Roche, GSK, Horizon, Inmedix, Janssen, Kezar, Lilly, Merck, Novartis, Pfizer, Regeneron, Samsung, Sandoz, Sanofi, Servier, UCB., Sarah Ormseth: None declared