AB1388-HPR TREATMENT ADHERENCE AMONG PATIENTS WITH INFLAMMATORY ARTHRITIDES TREATED WITH BDMARDS: AN OBSERVATIONAL STUDY USING I-CQR5 QUESTIONNAIRE AND THE ADMINISTRATIVE CLAIMS DATABASE
Authors: Letizia Moino, Desirée Bastarolo, Cristiana Visentin, Francesca Ometto, Ernesto De Menis, Cecilia Giron, Costantino Botsios
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Effective treatments have been introduced for inflammatory arthritides (IAs) in the last decades. However, adherence remains suboptimal. <h3>Objectives</h3> The aim of the study was to assess treatment adherence among patients with IAs treated with bDMARDs in a community hospital with the Italian 5-item Compliance Questionnaire for Rheumatology (I-CQR5) [1] and the hospital administrative claims database. <h3>Methods</h3> We conducted a monocentric, cross-sectional, observational study in IA patients (disease duration &gt;1 year, undergoing treatment with self-administered bDMARDs, capable to complete the questionnaire unaided) recruited in a community hospital from February to October 2018. Treatment adherence was defined according to I-CQR5 and to the Medication Possession Ratio (MPR) obtained from the claims database. To investigate variables associated with adherence, demographic, social, and clinical characteristics were considered. I-CQR5 has 5 questions, with Likert-answering scale ranging from 1 to 4, an algorithm allows to classify the patient as poorly or highly adherent (i.e. likely to take &gt;=80% of their medications correctly) [1]. MPR was obtained by dividing the number of dosage units withdrawn by patients by the prescribed number of dosage units. Agreement between the I-CQR5 and MPR definition of high adherence definitions was tested with McNemars test, while the association with patients characteristics with chi-square or Fishers exact test. <h3>Results</h3> A total 174 patients completed the I-CQR5 (median age 60 years, range 51-67; 37% males), affected by ankylosing spondylitis (16%), rheumatoid arthritis (RA) (62%), psoriatic arthritis (22%) with a median duration of 15 years (range 10-20). Etanercept (49%), adalimumab (20%), abatacept (8%) and tocilizumab (7.5%) were the most prescribed first-line biologics. Association with a conventional synthetic DMARDs was prescribed to 3.4% of subjects. High adherence rate, assessed with I-CQR5, was 83% overall, and 85% in RA patients. Significant differences were observed between highly and poorly adherent patients according to I-CQR5: lower educational status (lower primary or secondary school, and the use of cDMARDs were associated with poor adherence (both with p&lt;0.001); while the use of bDMARDs was negatively associated with high adherence (p&lt;0.05). High adherence rate measured with MPR was 72%. The agreement between high adherence, measured with I-CQR5 and MPR, was low p=0.005). <h3>Conclusion</h3> The study showed that IA patients treated with bDMARDs with a higher educational level are more adherent to physician prescription, as assessed by I-CQR5. I-CQR5 might overestimate adherence compared to MPR. In our study, the high adherence rate measured with I-CQR5 was higher compared with a report from a large outpatient clinic in the same area, which was limited to RA patients (85% vs 40,1%) [1] Our study may suggest that adherence benefits more from a close and stable relationship with the health care practitioner, such as in our centre, which is smaller than large outpatients clinics in which patients are followed by a health care professionals equipe rather than a single physician. <h3>References</h3> [1] Ometto F, et al. Ann Rheum Dis 2018;77(Suppl): A1322. <h3>Disclosure of Interests</h3> None declared