title: Influence of route of administration/drug formulation and other factors on adherence to treatment in rheumatoid arthritis (pain related) and dyslipidemia (non-pain related).
abstract: A comprehensive review was performed to investigate the effect of route of administration on medication adherence and persistence in rheumatoid arthritis (RA) and to compare adherence/persistence with oral medications between RA and a non-painful disease (dyslipidemia).
  
  
  
  Comprehensive database searches were performed to identify studies investigating medication adherence and/or persistence in adults with RA receiving conventional synthetic or biologic agents. Similar searches were performed for studies of patients with dyslipidemia receiving statins. Studies had to be published after 1998 in English and involve ≥6 months' follow up.
  
  
  
  Adherence and persistence were compared between the different routes of drug administration in RA, and between the two diseases for oral medications.
  
  
  
  A total of 35 and 28 papers underwent data extraction for RA and dyslipidemia, respectively. Within the constraints of the analysis, adherence and persistence rates appeared broadly similar for the different routes of drug administration in RA. Adherence to oral medications was also broadly similar across the two diseases, but persistence was lower in dyslipidemia. Poor adherence has clinical consequences in both diseases: greater disease activity and risk of flare in RA, and increased serum cholesterol levels and risk of heart and cerebrovascular disease in dyslipidemia. Over 1-3 years, poor adherence to biologic RA medications led to increased resource use and medical costs but lower total direct costs due to reduced biologic drug costs. Conversely, poor adherence to dyslipidemia medications resulted in increased total direct costs. In both diseases, adherence improved with patient education/support.
  
  
  
  The route of drug administration and the symptomatic (pain) nature of the disease do not appear to be dominant factors for drug adherence or persistence in RA.
  
  
  
  The wide range of adherence and persistence values and definitions across studies made comparisons between drug formulations and diseases difficult.
authors.affiliation: a Pierre et Marie Curie University, Sorbonne Universités ; and Rheumatology Department, Pitié Salpêtrière Hospital , Paris , France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Fautrel
authors.affiliation: b Rheumatology Department and Health Research Institute (Idipaz) , Hospital Universitario de La Paz , Madrid , Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Balsa
authors.affiliation: c Scientific Institute for Quality of Healthcare, Radboud University Medical Center , Nijmegen , and Department of Rheumatology , Bernhoven, Uden , The Netherlands.
authors.forename: Piet
authors.initials: P
authors.lastname: Van Riel
authors.affiliation: d Lilly SA, Alcobendas , Madrid , Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Casillas
authors.affiliation: e Lilly France , Neuilly-sur-Seine , France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Capron
authors.affiliation: e Lilly France , Neuilly-sur-Seine , France.
authors.forename: Carine
authors.initials: C
authors.lastname: Cueille
authors.affiliation: d Lilly SA, Alcobendas , Madrid , Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: de la Torre
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002626:Chemistry, Pharmaceutical; D003365:Costs and Cost Analysis; D050171:Dyslipidemias / Q000188:drug therapy*; D006801:Humans; D055118:Medication Adherence; D010146:Pain / Q000188:drug therapy; D004364:Pharmaceutical Preparations / Q000008:administration & dosage
chemical_list: D018501:Antirheumatic Agents; D004364:Pharmaceutical Preparations
keywords: Drug formulation; dyslipidemias; patient adherence; rheumatoid arthritis