SAT0691 Adherence to disease-modifying drugs in chronic inflammatory rheumatic diseases: several questionnaires, diverse patient characteristics and some efficacious interventions – a systematic literature review
Authors: D. Puyraimond-Zemmour, X. Romand, M. Lavielle, A. Molto, P. Gaudin, M. Soubrier, C. Beauvais, D. Wendling, E. Senbel, S. Pouplin, R.-M. Flipo, C. Richez, A. Saraux, L. Gutermann, M. Mézière, M. Dougados, L. Gossec
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> In chronic inflammatory rheumatic diseases (CIRDs), adherence to disease-modifying drugs (DMD) is only moderate. Non-adherence may lead to complications, unnecessary treatment switches and heightened costs. Physicians are often at a loss when faced with non-adherence. <h3>Objectives</h3> To obtain an overview of how to measure adherence, who to screen particularly (risk factors of non adherence) and interventions to enhance medication adherence to DMD in patients with CIRDs. <h3>Methods</h3> A systematic literature review was performed in Pubmed, Cochrane, Embase and websites in 2017. All english and french studies related to methods to measure non-adherence, risk factors regrouped in 5 domains according to World Health Organisation (patient characteristics, health status, treatments, socio-economic conditions and relations with caregivers and the health system) and interventions for non-adherence regrouped in 5 modalities (educational, behavioural, cognitive behavioural, multicomponent interventions or others) were selected. The scope was limited to CIRDs (i.e., rheumatoid arthritis (RA), spondyloarthritis (SpA), psoriatic arthritis (PsA), cristal-induced arthritis (CIA), connective tissue diseases (CTD), vasculitis and auto-inflammatory diseases), and to DMD (i.e., mainly conventional DMARDs, biologics and targeted synthetic DMARDs). <h3>Results</h3> After screening 1131 publications and 194 other documents, 231 relevant papers were analysed for measuring adherence (60% in RA, 8% in SpA, 6% in PsA, 11% in CIA and 15% in CTD), 117 for predicting non-adherence (55% in RA, 9% in SpA, 14% in gout and 22% in CTD) and 22 for improving adherence (72% in RA, 8% in SpA, 16% in systemic lupus and 4% in gout). Objective measurements of non-adherence included: delivery data (total number of use: n=92), pill counts (n=8), medication event monitoring system (n=9), blood level assessments (n=7). Subjective measurements included: patient global assessment (n=57), and 4 questionnaires. The most used questionnaire was the Morisky Medication Adherence Scale and the most widely validated in rheumatology were the Compliance Questionnaire on Rheumatology and the Medication Adherence Self-report Inventory. Around 100 predictive factors were identified. Polymedication, mood disorders, lack of information and poor physician-patient relationship were associated with lower adherence. Regarding management options for non-adherence, 13/22 studies were randomised controlled trials (1535 patients) and only 5 (38%) were positive (774 patients). Educational interventions were the most represented with the highest level of evidence: 8/13 trials (1017 patients) with 4/8 yielding positive results. <h3>Conclusions</h3> Despite the importance of medication adherence in CIRDs, this review revealed limitations in methods to measure non-adherence, a multiplicity of non-adherence risk factors and a relative lack of evidence on interventions to improve medication adherence. It's important to improve the assessment and optimisation of adherence in CIRDs. <h3>Acknowledgements</h3> AbbVie France funded this initiative but played no role in the points to consider. <h3>Disclosure of Interest</h3> None declared