title: Impact of inadequate adherence on response to subcutaneously administered anti-tumour necrosis factor drugs: results from the Biologics in Rheumatoid Arthritis Genetics and Genomics Study Syndicate cohort.
abstract: OBJECTIVE
  Non-adherence to DMARDs is common, but little is known about adherence to biologic therapies and its relationship to treatment response. The purpose of this study was to investigate the association between self-reported non-adherence to s.c. anti-TNF therapy and response in individuals with RA.
  
  
  METHODS
  Participants about to start s.c. anti-TNF therapy were recruited to a large UK multicentre prospective observational cohort study. Demographic information and disease characteristics were assessed at baseline. Self-reported non-adherence, defined as whether the previous due dose of biologic therapy was reported as not taken on the day agreed with the health care professional, was recorded at 3 and 6 months following the start of therapy. The 28-joint DAS (DAS28) was recorded at baseline and following 3 and 6 months of therapy. Multivariate linear regression was used to examine these relationships.
  
  
  RESULTS
  Three hundred and ninety-two patients with a median disease duration of 7 years [interquartile range (IQR) 3-15] were recruited. Adherence data were available in 286 patients. Of these, 27% reported non-adherence to biologic therapy according to the defined criteria at least once within the first 6-month period. In multivariate linear regression analysis, older age, lower baseline DAS28 and ever non-adherence at either 3 or 6 months from baseline were significantly associated with a poorer DAS28 response at 6 months to anti-TNF therapy.
  
  
  CONCLUSIONS
  Patients with RA who reported not taking their biologic on the day agreed with their health care professional showed poorer clinical outcomes than their counterparts, emphasizing the need to investigate causes of non-adherence to biologics.
authors.affiliation: Arthritis Research UK Centre for Genetics and Genomics, University of Manchester, National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester Foundation Trust and University of Manchester, Manchester Academic Health Science, Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, National Institute of Health Research Leeds Musculoskeletal Biomedical Research Unit, Leeds, Academic Unit of Rheumatology, Department of Infection and Immunity, University of Sheffield Medical School, Sheffield, Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University and National Institute of Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne and Institute for Inflammation and Repair, University of Manchester, Manchester, UK.
authors.forename: James
authors.initials: J
authors.lastname: Bluett
authors.affiliation: Arthritis Research UK Centre for Genetics and Genomics, University of Manchester, National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester Foundation Trust and University of Manchester, Manchester Academic Health Science, Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, National Institute of Health Research Leeds Musculoskeletal Biomedical Research Unit, Leeds, Academic Unit of Rheumatology, Department of Infection and Immunity, University of Sheffield Medical School, Sheffield, Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University and National Institute of Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne and Institute for Inflammation and Repair, University of Manchester, Manchester, UK.
authors.forename: Catharine
authors.initials: C
authors.lastname: Morgan
authors.affiliation: Arthritis Research UK Centre for Genetics and Genomics, University of Manchester, National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester Foundation Trust and University of Manchester, Manchester Academic Health Science, Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, National Institute of Health Research Leeds Musculoskeletal Biomedical Research Unit, Leeds, Academic Unit of Rheumatology, Department of Infection and Immunity, University of Sheffield Medical School, Sheffield, Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University and National Institute of Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne and Institute for Inflammation and Repair, University of Manchester, Manchester, UK.
authors.forename: Layla
authors.initials: L
authors.lastname: Thurston
authors.affiliation: Arthritis Research UK Centre for Genetics and Genomics, University of Manchester, National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester Foundation Trust and University of Manchester, Manchester Academic Health Science, Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, National Institute of Health Research Leeds Musculoskeletal Biomedical Research Unit, Leeds, Academic Unit of Rheumatology, Department of Infection and Immunity, University of Sheffield Medical School, Sheffield, Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University and National Institute of Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne and Institute for Inflammation and Repair, University of Manchester, Manchester, UK.
authors.forename: Darren
authors.initials: D
authors.lastname: Plant
authors.affiliation: Arthritis Research UK Centre for Genetics and Genomics, University of Manchester, National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester Foundation Trust and University of Manchester, Manchester Academic Health Science, Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, National Institute of Health Research Leeds Musculoskeletal Biomedical Research Unit, Leeds, Academic Unit of Rheumatology, Department of Infection and Immunity, University of Sheffield Medical School, Sheffield, Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University and National Institute of Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne and Institute for Inflammation and Repair, University of Manchester, Manchester, UK.
authors.forename: Kimme L
authors.initials: KL
authors.lastname: Hyrich
authors.affiliation: Arthritis Research UK Centre for Genetics and Genomics, University of Manchester, National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester Foundation Trust and University of Manchester, Manchester Academic Health Science, Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, National Institute of Health Research Leeds Musculoskeletal Biomedical Research Unit, Leeds, Academic Unit of Rheumatology, Department of Infection and Immunity, University of Sheffield Medical School, Sheffield, Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University and National Institute of Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne and Institute for Inflammation and Repair, University of Manchester, Manchester, UK.
authors.forename: Ann W
authors.initials: AW
authors.lastname: Morgan
authors.affiliation: Arthritis Research UK Centre for Genetics and Genomics, University of Manchester, National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester Foundation Trust and University of Manchester, Manchester Academic Health Science, Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, National Institute of Health Research Leeds Musculoskeletal Biomedical Research Unit, Leeds, Academic Unit of Rheumatology, Department of Infection and Immunity, University of Sheffield Medical School, Sheffield, Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University and National Institute of Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne and Institute for Inflammation and Repair, University of Manchester, Manchester, UK.
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Wilson
authors.affiliation: Arthritis Research UK Centre for Genetics and Genomics, University of Manchester, National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester Foundation Trust and University of Manchester, Manchester Academic Health Science, Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, National Institute of Health Research Leeds Musculoskeletal Biomedical Research Unit, Leeds, Academic Unit of Rheumatology, Department of Infection and Immunity, University of Sheffield Medical School, Sheffield, Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University and National Institute of Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne and Institute for Inflammation and Repair, University of Manchester, Manchester, UK.
authors.forename: John D
authors.initials: JD
authors.lastname: Isaacs
authors.affiliation: Arthritis Research UK Centre for Genetics and Genomics, University of Manchester, National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester Foundation Trust and University of Manchester, Manchester Academic Health Science, Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, National Institute of Health Research Leeds Musculoskeletal Biomedical Research Unit, Leeds, Academic Unit of Rheumatology, Department of Infection and Immunity, University of Sheffield Medical School, Sheffield, Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University and National Institute of Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne and Institute for Inflammation and Repair, University of Manchester, Manchester, UK. lis.cordingley@manchester.ac.uk.
authors.forename: Lis
authors.initials: L
authors.lastname: Cordingley
authors.affiliation: Arthritis Research UK Centre for Genetics and Genomics, University of Manchester, National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester Foundation Trust and University of Manchester, Manchester Academic Health Science, Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, National Institute of Health Research Leeds Musculoskeletal Biomedical Research Unit, Leeds, Academic Unit of Rheumatology, Department of Infection and Immunity, University of Sheffield Medical School, Sheffield, Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University and National Institute of Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne and Institute for Inflammation and Repair, University of Manchester, Manchester, UK. Arthritis Research UK Centre for Genetics and Genomics, University of Manchester, National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester Foundation Trust and University of Manchester, Manchester Academic Health Science, Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, National Institute of Health Research Leeds Musculoskeletal Biomedical Research Unit, Leeds, Academic Unit of Rheumatology, Department of Infection and Immunity, University of Sheffield Medical School, Sheffield, Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University and National Institute of Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne and Institute for Inflammation and Repair, University of Manchester, Manchester, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Barton
mesh_terms: D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000453:epidemiology / Q000235:genetics; D001688:Biological Products / Q000008:administration & dosage* / Q000627:therapeutic use*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007279:Injections, Subcutaneous; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D011446:Prospective Studies; D057566:Self Report; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha
keywords: adherence; behaviour; biologic therapies; outcome measures; rheumatoid arthritis