title: Adherence to Anti-Tumor Necrosis Factor Therapy Administered Subcutaneously and Associated Factors in Patients With Rheumatoid Arthritis.
abstract: BACKGROUND
  Adherence to biologic therapy is relatively poorly studied in rheumatoid arthritis (RA) because many of the studies have investigated the drug persistence, which represents only a surrogate of adherence.
  
  
  OBJECTIVE
  The aims of this study were to determine the extent of adherence in RA patients with subcutaneously administered anti-tumor necrosis factor methotrexate agents and to identify the risk factors for nonadherence.
  
  
  METHODS
  A cohort of RA patients who started a subcutaneous anti-tumor necrosis factor treatment were enrolled. After 12 months of treatment, all patients completed the 4-item Morisky Medication Adherence Scale questionnaire. Associations between beliefs and nonadherence and the influence of demographic, clinical, and radiographic features were assessed using logistic regression model.
  
  
  RESULTS
  A total of 209 (80.4%) of the 260 patients were included in the analyses. Forty-three of 209 patients were considered nonadherent to their medication (20.6%) according to the 4-item Morisky Medication Adherence Scale. More than half (53.1%) of patients showed at least 1 form of nonadherent behavior.The logistic model showed that low disease activity (P = 0.003), higher patient-physician discordance ratings (P = 0.012), older age (P = 0.041), and a high number of comorbid conditions (P = 0.011) were significantly associated with increased likelihood of nonadherence.
  
  
  CONCLUSIONS
  The overall nonadherence with subcutaneous biologic therapy is relatively high among RA patients and should be taken into account when a patient's response to treatment is unsatisfactory.
authors.affiliation: From the *Rheumatology Department,; †Radiology Department, and ‡DII, Department of Information Engineering, Polytechnic University of Marche, Jesi, Ancona, Italy; and §Musculoskeletal Department, National Rehabilitation Institute, Mexico City, Mexico.
authors.forename: Fausto
authors.initials: F
authors.lastname: Salaffi
authors.forename: Marina
authors.initials: M
authors.lastname: Carotti
authors.forename: Marco
authors.initials: M
authors.lastname: Di Carlo
authors.forename: Sonia
authors.initials: S
authors.lastname: Farah
authors.forename: Marwin
authors.initials: M
authors.lastname: Gutierrez
mesh_terms: D000367:Age Factors; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D001691:Biological Therapy / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D062072:Patient Acuity; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D016903:Drug Monitoring
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha