Background: Treatment adherence is a major challenge in chronic inflammatory rheumatic diseases. Mainly studied in rheumatoid arthritis (RA), adherence rates range from 30 to 80% [1]. Given the impact of non-adherence to disease-modifying therapy among RA patients, guidelines aiming to facilitate adherence’s management were published in 2019 [2]. These guidelines highlight the multifactorial characteristics and importance of clarifying the factors contributing to non-adherence. Additionally, an EULAR task force highlighted the importance of addressing treatment adherence in the management of difficult-to-treat RA [3].

Objectives: Based on STRATEGE2 results, we investigated real-life treatment adherence in RA patients treated with methotrexate (MTX) at time of initiation of a first b/tsDMARD and during a two-year follow-up.

Methods: The STRATEGE2 cohort included RA patients who have been treated with MTX for at least 3 months (M) and were eligible for the initiation of their first targeted biological (bDMARD) or synthetic (tsDMARD) therapy due to RA activity. At 3 steps (baseline, M12 and M24) patients completed the Compliance Questionnaire for Rheumatology (CQR) [4], a 19-item self-administered questionnaire specifically designed for rheumatology to assess treatment adherence. A CQR19≤80 indicates a non-adherent patient (N-Ad). The profile of N-Ad at all 3 steps were compared with the profile of patients considered adherent (Ad) at least once during these steps. In addition, participation in shared decision-making (SDM) was evaluated using a 5-point Likert scale, adapted for both patient and physician use.

Results: Between Feb. 2019 and Dec. 2020, 180 RA patients were enrolled, with 100 patients having an analyzable CQR19 at all 3 steps. Patient were divided in 2 groups: 32 patients were N-Ad throughout the study and 68 were Ad at least once. At baseline, no significant difference in patient profiles (except in MTX route): 75.0% females, mean age 57.2±12.8 years, diagnosed 6.1±7.8 years previously, treatment with MTX for 4.8±5.5 years and a mean MTX dose 18.9±4.2 mg/week. B/tsDMARD management was identical for both groups with 92.0% bDMARD and 8.0% tsDMARD initiation. The evolution of the therapeutic strategy over 24 months showed no difference between the 2 groups. 55.0% of patients had at least one adaptation to their b/tsDMARD treatment and 16.0% discontinued this treatment. The mean dose of MTX decreased overall to 14.9±4.7 mg/week and only 21.0% of patients discontinued it. The main difference between the 2 groups was the significant (p<0.05) lowest use of MTX SC route in N-Ad vs. Ad at the 3 steps (Baseline: 62.5% vs. 86.8%, M12: 38.5% vs. 68.3%, and M24: 38.5% vs. 64.2%). Between inclusion and 24M, RA activity decreased in both patients’ group (NS).

Evolution of Patients and Physicians perception of their SDM participation during 24M:

Conclusion: This analysis comparing the profiles of N-Ad patients to treatment throughout the study vs Ad patients at least once, identifies 2 particularities of N-Ad patients. During the 24 months follow-up period, N-Ad used MTX SC route less than Ad patients, and feel less involved in SDM, although this perception is not shared by the physician.

REFERENCES: [1] Beauvais C, et al. Joint Bone Spine 2020;87(6):668-669.

[2] Gossec C, et al. Joint Bone Spine 2019;86(1):13-19.

[3] Nagy G, et al. Ann Rheum Dis 2021;0:1–14.

[4] De Klerk E, et al. J Rheumatol 2003;30(11):2469-2475

Acknowledgements: The authors wish to acknowledge RCTs for their contribution to the statistical analysis, the investigators, centres and patients.

Disclosure of Interests: Cécile Gaujoux-Viala AbbVie; Amgen; Boehringer Ingelheim, Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences, Inc.; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; UCB Pharma and Viatrix., AbbVie; Amgen; Boehringer Ingelheim, Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences, Inc.; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; UCB Pharma and Viatrix., Emmanuelle Dernis AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, MSD, Nordic Pharma, Novartis, Pfizer, Roche, Roche-Chugaï, Sandoz, Sanofi and UCB Pharma., AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, MSD, Nordic Pharma, Novartis, Pfizer, Roche, Roche-Chugaï, Sandoz, Sanofi and UCB Pharma., Eric Senbel Abbvie, Amgen, Biogen, Celltrion, Fresenius Kabi, Janssen, Lilly, MSD, Nordic Pharma, Pfizer, Roche-Chugai Sandoz and Sanofi, Abbvie, Amgen, Biogen, Celltrion, Fresenius Kabi, Janssen, Lilly, MSD, Nordic Pharma, Pfizer, Roche-Chugai Sandoz and Sanofi, Hélène Herman-Demars Nordic Pharma France, Jennifer Becker Nordic Pharma France, Agnès Courbeyrette Nordic Pharma France, René-Marc Flipo Abbvie, Amgen, Bristol-Myers Squibb, Galapagos, Janssen-Cilag, Lilly, Medac, MSD, Nordic-Pharma, Novartis, Pfizer, Roche-Chugaï, Sandoz and Sanofi-Genzyme, Abbvie, Amgen, Bristol-Myers Squibb, Galapagos, Janssen-Cilag, Lilly, Medac, MSD, Nordic-Pharma, Novartis, Pfizer, Roche-Chugaï, Sandoz and Sanofi-Genzyme.