SAT0629 THERE ARE 4 MAIN QUESTIONNAIRES TO ASSESS ADHERENCE IN INFLAMMATORY ARTHRITIS BUT NONE OF THEM PERFORM WELL: A SYSTEMATIC LITERATURE REVIEW
Authors: Déborah Puyraimond-Zemmour, Xavier Romand, Matthieu Lavielle, Anna Moltó, Rene-Marc Flipo, Christophe Richez, Alain Saraux, Loriane Gutermann, Maryse Mezière, Maxime Dougados, Laure Gossec
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Insufficient patient adherence to treatments in inflammatory arthritis (IA) including rheumatoid arthritis (RA), spondyloarthritis (SpA), psoriatic arthritis (PsA), crystal-induced arthritis and connective tissue diseases (CTD) may lead to complications, unnecessary treatment switches, and increased costs. Patient adherence to treatment should be assessed, however how to evaluate it has not been determined. <h3>Objectives:</h3> To assess the psychometric properties of questionnaires to measure adherence to treatment in IA. <h3>Methods:</h3> We performed a systematic literature review (SLR) using three central databases (Pubmed, Cochrane, Embase) and several websites in January 2019. The scope was limited to IA (i.e., RA, SpA, PsA, CTD, crystal-induced arthritis, vasculitis, and auto-inflammatory diseases), and disease-modifying drugs (i.e., mainly conventional DMARDs, biologics and targeted synthetic DMARDs). All questionnaires used to assess adherence were collected, then a specific search using the questionnaire name was run to obtain data on their psychometric properties including overall validity (sensitivity (Se), specificity (Sp) and Cronbach coefficient (CC), reliability, and sensitivity of change, following the OMERACT filter. These properties were analyzed semi-quantitatively. <h3>Results:</h3> After screening 1209 publications and 194 other documents, 242 relevant papers were analyzed for measuring adherence (63.6% in RA, 8.7% in SpA, 6.6% in PsA, 14.5% in CIA and 19.0% in CTD). The number of articles using adherence questionnaires by disease was: 69/154 in RA, 14/21 in SpA, 27/40 in systemic lupus erythematosus (SLE), 9/16 in PsA, 8/35 in crystal induced arthritis and 4/6 in other CTD. Four questionnaires were used to evaluate drug adherence (Table 1). The most used questionnaire was the MMAS in all diseases except in RA where the CQR was more used. The CQR was validated in 85 patients with IA against as external standard, electronic medication monitoring (Se 62 to 98%, Sp 67 to 97% and CC of 0.71 to 0.85). The MASRI was validated in 55 patients with SLE against adherence based on pharmacy refill information (Se 87%, Sp 86% and CC of 0.70). The MMAS was validated in 91 patients with gout against medication possession ratio Se 81 to 93%, Sp 44 to 53% and CC of 0.54). The MARS was validated in 108 patients with RA (Se 13 to 53%, Sp 57 to 94% and CC 0.60 to 0.75). Reproducibility was correct but copyright posed isses (Table). The + represents a semi-quantitative summary of the available literature with more + meaning higher/better results (from - to +++) <h3>Conclusion:</h3> Four questionnaires are being used to measure medication non-adherence in IA; the most used is the MMAS which is unfortunately copyrighted and not fully validated in rheumatology. The CQR and MASRI questionnaires were the most validated in rheumatology, but the CQR is long and the MASRI only used for SLE. Thus it appears that to date, a simple, reliable and valid questionnaire to assess drug adherence is lacking. <h3>References</h3> [1] De Klerk E. et al., J. Rheumatol. 2003; Thompson K. et al., Schizophr Res 2000; Walsh JC. et al., AIDS. 2002; Morisky DE. et al., J Clin Hypertens (Greenwich) 2008 <h3>Acknowledgement:</h3> AbbVie France funded this initiative. <h3>Disclosure of Interests:</h3> Dborah Puyraimond-Zemmour Grant/research support from: Abbvie, Xavier Romand Grant/research support from: Abbvie, Matthieu Lavielle Grant/research support from: Abbvie, Anna Molt: None declared, Rene-Marc Flipo Consultant for: Advisory board: Bristol-Myers Squibb, Christophe Richez: None declared, Alain Saraux Consultant for: Roche SAS, Speakers bureau: Chugai Pharma France, Loriane Gutermann: None declared, Maryse Mezire Grant/research support from: Abbvie, maxime dougados Grant/research support from: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Consultant for: Eli Lilly and Company, Pfizer, AbbVie, and UCB Pharma, Laure Gossec Grant/research support from: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis-Sandoz, Pfizer, Sanofi, and UCB, Consultant for: AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, MSD, Nordic Pharma, Novartis-Sandoz, Pfizer, Roche, Sanofi, and UCB, Consultant for: L Gossec has received honoraria from Celgene as investigator for this study.