AB0433 TREATMENT PATTERNS AMONG PATIENTS WITH RHEUMATOID ARTHRITIS WHO RECEIVE METHOTREXATE: TARGETED LITERATURE REVIEW
Authors: Andrew Ostor, Matthew Wallace, Ruth Zeidman, Vishvas Garg, Ruta Sawant
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Methotrexate (MTX) monotherapy or in combination with other disease modifying agents is a common first-line treatment option for patients with rheumatoid arthritis (RA). However, treatment patterns and associated patients' perceptions and preferences of MTX therapy may not be fully understood. <h3>Objectives:</h3> To assess treatment patterns of MTX therapy in RA by evaluating real-world adherence and persistence, patients' preferences and reasons for discontinuation, as well as the economic burden of therapy. <h3>Methods:</h3> A targeted review of the literature published between January 2010 and March 2018 was conducted by searching the MEDLINE and EMBASE databases. Searches were limited to English-language articles and included original research and reviews. All articles were assessed for relevance, in terms of study methodology, patient population and outcomes by a single reviewer. <h3>Results:</h3> The search resulted in 444 hits of which 29 articles were included in the qualitative synthesis. Data pertaining to adherence and patient-reported reasons for non-adherence were extracted from 11 publications. MTX therapy non-adherence was high, with up to 42% of patients reporting not taking MTX as prescribed. Among these patients, many reported taking smaller doses than prescribed (53%) or intentionally skipping doses (52%). Common patient-reported reasons for non-adherence included upcoming surgery, and experience of, or concerns regarding, adverse events (AEs). Data pertaining to therapy discontinuation were extracted from 21 publications. Across the studies sampled, rates of discontinuation at one year were 24–50%. MTX toxicity was responsible for 5–34% of all discontinuations. Among patients who switched from orally to parenterally administered MTX, 29% discontinued due to gastrointestinal AEs within one year. Patient-reported reasons for therapy discontinuation, other than experiencing AEs, included concerns regarding MTX AEs, drug price and lack of perceived need. No studies examining the costs associated with MTX monotherapy monitoring and AE management were identified in the search. <h3>Conclusion:</h3> Findings from the review indicated that MTX therapy is associated with substantial non-adherence and discontinuation, thus adding to patient burden. Patient-reported reasons for non-adherence/poor treatment persistence were varied but most commonly included experience of, or concerns regarding AEs. <h3>Acknowledgement:</h3> The design, study conduct, and financial support for the study were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of this publication. <h3>Disclosure of Interests:</h3> Andrew Ostor Consultant for: AbbVie, BMS, Roche, Janssen, Lilly, Novartis, Pfizer, UCB, Gilead, Paradigm, Matthew Wallace Employee of: Covance Market Access &amp; Phase IV Solutions, which has received consultancy fees from AbbVie, Ruth Zeidman Employee of: Covance Market Access &amp; Phase IV Solutions, which has received consultancy fees from AbbVie, Vishvas Garg Shareholder of: AbbVie, Employee of: AbbVie, Ruta Sawant Shareholder of: AbbVie, Employee of: AbbVie