AB0212 NON-ADHERENCE IN RHEUMATOLOGIC IMMUNE-MEDIATED DISEASES

Abstract

Background: Patient adherence is a key determinant of treatment success in rheumatologic immune-mediated diseases. Available data about adherence to biological treatments and factors associated to non-adherence is limited in Spain. Moreover, no studies compare adherence between subcutaneous and oral drugs. Objectives: To evaluate non-adherence to prescribed subcutaneous biologicals and oral drugs in patients with rheumatologic immune-mediated diseases and to assess possible predictor factors associated to treatment non-adherence. Methods: Retrospective observational study including all patients with oral and subcutaneous treatment for rheumatologic immune-mediated diseases from 2017 to 2019 in the outpatient pharmaceutical care area from a tertiary university hospital. Non-adherence was evaluated by reviewing all scheduled drug-dispensing visits in the computerized application. We considered non-adherent every time that a patient missed at least one drug administration. Data collected: demographic, total patients and patient-treatments, total dispensing visits and route of administration for drug dispensed in every visit. We classified patients in adherent and non-adherent considering dispensing visits. Non-adherent group: number of dispensing visits, reasons for non-adherence, number of missed administrations per patient and drug and predictor factors for non-adherence. Results: 783 patients included: 52.4(13.7) years; 427(54.5%) female; 164 (20.9%) smoker; 697 (89%) Caucasian. A total of 79 (10.1%) of 783 patients received more than one treatment. 869 patient-treatments: 294 adalimumab (33.8%), 236 etanercept (27.2%), 78 golimumab (8.9%), 47 apremilast (5.4%), 39 certolizumab (4.5%), 34 secukinumab (3.9%), 30 tocilizumab (3.5%). 9,197 dispensing visits. Route of administration: 6,406 subcutaneous (93.2%), 374 oral (6.8%). Non-adherence analysis: 2417 (26.3%) dispensing visits, reasons for non-adherence/ dispensing visits: 92 unjustified (97.5%), 33 infection (1.4%), 18 (surgery) 0.7%, 3 pregnancy (0.1%), 6 others (0.3%). Number of missed administrations/patient treatment: 675 patients missed at least one administration (77.7%).Mean 2.5 (±12.9) missed administrations. Number of missed administrations/drug: 9.9 baricitinib (±20.8), 15.8 tofacitinib (±31.2), 25.4 apremilast (±53.2). Predictor factors for non-adherence: ethnicity (p=0.015), treatment with golimumab (p=0.006), and tocilizumab (p=0.036). Age (p=0.072). Conclusion: -Non-adherence to the prescribed drug occurred in 77.7% of patients with rheumatologic immune-mediated diseases -Demographic factors such as ethnicity as well as golimumab and tocilizumab treatment, despite their different frequency of administration, were predictors for non-adherence -Route of administration did not influence non-adherence.