title: Adherence to biologic therapies and associated factors in rheumatoid arthritis, spondyloarthritis and psoriatic arthritis: a systematic literature review.
abstract: OBJECTIVE
  To analyse the evidence on adherence to biologic therapies in rheumatoid arthris (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA).
  
  
  METHODS
  Systematic review of studies retrieved by a sensitive search strategy in MEDLINE database (1961 through March 2012). To be selected, studies had to include patients with RA, SpA, or PsA, treatment with intravenous or subcutaneous biologic therapies, and had to report on measures of adherence. By design, only randomised controlled trials (RCT) or high quality cohort studies with a control group were selected.
  
  
  RESULTS
  A total of 24 studies were included, of which 12 reported results from national or local biologic registers, 9 were retrospective studies, 2 prospective studies, and only one was an RCT. Patients included were mostly women with diagnosis of RA or SpA and, less frequently, PsA. There was a great variability in the definition of adherence, measurement methods, and associated factors analysed. In general, adherence to etanercept was superior to that of other biologics, by the measures utilised. The main predictive factors - age, sex, comorbidity, baseline clinical condition, previous or concomitant use of DMARDs, anti-TNF in monotherapy or in combination with MTX - produced diverse, even divergent results across studies.
  
  
  CONCLUSIONS
  There is a wide variability related to the adherence concept and its measurement, reflecting the complexity of the phenomenon. In order to draw more consistent conclusions about the relative value of predictive factors on adherence and persistence of biological therapy, larger controlled studies with better selection of variables and analysis of interactions are needed.
authors.affiliation: Complejo Hospitalario de Zamora, Zamora, Spain.
authors.forename: Ruth
authors.initials: R
authors.lastname: López-González
authors.affiliation: Rheumatology Unit, Instituto de Investigacion Sanitaria, Hospital Clinico San Carlos, Madrid; and Health Sciences Department, School of Psychology, Universidad Camilo Jose Cela, Madrid, Spain.
authors.forename: Leticia
authors.initials: L
authors.lastname: León
authors.affiliation: Instituto de Salud Musculoesquelética, Madrid, Spain.
authors.forename: Estibaliz
authors.initials: E
authors.lastname: Loza
authors.affiliation: Health Sciences Department, School of Psychology, Universidad Camilo Jose Cela, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Redondo
authors.affiliation: Instituto de Salud Musculoesquelética, Madrid, Spain.
authors.forename: Maria Jesus
authors.initials: MJ
authors.lastname: Garcia de Yébenes
authors.affiliation: Instituto de Salud Musculoesquelética, Madrid, Spain.
authors.forename: Loreto
authors.initials: L
authors.lastname: Carmona
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000188:drug therapy / Q000276:immunology; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000276:immunology; D001691:Biological Therapy / Q000379:methods / Q000706:statistics & numerical data; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D054539:Medication Therapy Management; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D025241:Spondylarthritis / Q000188:drug therapy / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology; D016903:Drug Monitoring
chemical_list: D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D011993:Recombinant Fusion Proteins; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept