title: Non-adherence to subcutaneous biological medication in patients with rheumatoid arthritis: a multicentre, non-interventional study.
abstract: OBJECTIVE
  To evaluate non-adherence to prescribed subcutaneous biologicals in rheumatoid arthritis (RA) patients in Spain.
  
  
  METHODS
  ARCO (Study on Adherence of Rheumatoid Arthritis patients to SubCutaneous and Oral Drugs) was a multicentre, non-interventional retrospective study involving 42 rheumatology clinics from representative hospitals throughout Spain. The primary objective was to assess the percentage of patients (aged ≥18 years with an established RA diagnosis) with non-adherence to prescribed subcutaneous biologicals using clinical records and hospital pharmacy dispensing logs as the primary information sources. Adherence was assessed using the Medication Possession Ratio (MPR). Additionally, patients completed the Morisky-Green Medication Adherence Questionnaire.
  
  
  RESULTS
  A total of 364 patients (77.5% females, mean age 54.9 years, median RA duration since diagnosis 7.8 years) were enrolled in ARCO. Non-adherence (MPR ≤80%) was reported in 52/363 evaluable patients (14.3%), and was lower in patients receiving initial monthly drug administration (6.4%) than with weekly (17.4%; p=0.034) or every two weeks (14.4%; p=0.102) administration. By multivariate analysis, non-adherence was positively associated with RA duration above the median and with using induction doses. Monthly administration, compared to weekly administration, was inversely associated with non-adherence. Age, gender, order of administration, and changes in the interval of administration, showed no association with non-adherence. Compared with the MPR, the Morisky-Green questionnaire performed poorly in detecting non-adherence.
  
  
  CONCLUSIONS
  Non-adherence to the prescribed subcutaneous biological drug occurred in 14.3% of patients with RA. Patients using the most convenient administration period (i.e. monthly) had better adherence than those using more frequent dosing schedules.
authors.affiliation: Hospital Txagorritxu, Araba, Vitoria, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Calvo-Alén
authors.affiliation: Hospital Universitario Gregorio Marañón, Madrid, Spain. indalecio.monteagudo@salud.madrid.org.
authors.forename: Indalecio
authors.initials: I
authors.lastname: Monteagudo
authors.affiliation: Hospital Universitario Mutua de Terrassa, Barcelona, Spain.
authors.forename: Georgina
authors.initials: G
authors.lastname: Salvador
authors.affiliation: Hospital Universitario Lucus Augusti, Lugo, Spain.
authors.forename: Tomás R
authors.initials: TR
authors.lastname: Vázquez-Rodríguez
authors.affiliation: Hospital Universitario de Elche, Alicante, Spain.
authors.forename: Juan V
authors.initials: JV
authors.lastname: Tovar-Beltrán
authors.affiliation: Hospital Universitario de Alicante, Spain.
authors.forename: Paloma
authors.initials: P
authors.lastname: Vela
authors.affiliation: Complexo Universitario de Vigo-XXVI, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Maceiras
authors.affiliation: Hospital Universitario de Canarias, Tenerife, Spain.
authors.forename: Sagrario
authors.initials: S
authors.lastname: Bustabad
authors.affiliation: Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Román-Ivorra
authors.affiliation: Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: Consuelo
authors.initials: C
authors.lastname: Díaz-Miguel
authors.affiliation: Hospital Marina Baixa, Villajoyosa, Alicante, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Rosas
authors.affiliation: Hospital Universitario San Cecilio de Granada, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Raya
authors.affiliation: Instituto de Salud Musculoesquelética, Madrid, Spain.
authors.forename: Loreto
authors.initials: L
authors.lastname: Carmona
authors.affiliation: Medical Affairs, Merck Sharp & Dohme of Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Cea-Calvo
authors.affiliation: Medical Affairs, Merck Sharp & Dohme of Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Arteaga
authors.affiliation: Medical Affairs, Merck Sharp & Dohme of Spain.
authors.forename: Sabela
authors.initials: S
authors.lastname: Fernández
authors.affiliation: Hospital Universitario Virgen de Arrixaca, Murcia, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Marras
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D001688:Biological Products / Q000008:administration & dosage* / Q000009:adverse effects; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D055104:Infusions, Subcutaneous; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products