Objectives: Despite evidence of suboptimal adherence to Methotrexate (MTX), it remains the preferred initial antirheumatic drug. Several different tools assess overall medication adherence in rheumatoid arthritis (RA) but none is specific to MTX and adapted for routine clinical practice. The objective was to develop a tool to identify MTX-treated patients likely to be poor adherent to the medication, for use in routine clinical practice and in research studies. Methods: Exploratory interviews were conducted with 32 RA patients (US patients) currently or previously treated canwith MTX alone or in combination, to explore their experience. Qualitative analysis was performed to develop a conceptual model of the factors influencing adherence to MTX. Based on this model, items were generated using patients' verbatim, and comprehension tested with 18 RA patients. Acceptability and applicability of the resulting pilot version were then assessed in clinical practice during consultation, with 10 rheumatologists, using the PRAgmatic Content and face validity Test. Results: Several factors associated with poor adherence to MTX were elicited from the analysis of the exploratory interviews: barriers (practical, physical, emotional, cognitive, financial), side effects, treatment perceived efficacy; doctor-related factors, patients' beliefs, expectations and behaviors towards treatment, and external sources. The resulting MTX Adherence Questionnaire included 29 questions, plus three about MTX administration mode and dose, divided into 5 sections: "Practical aspects of MTX"; "Me and MTX"; "Efficacy of MTX"; "My feelings about MTX"; "My opinion regarding my care"; "MTX treatment in general". Rheumatologists accepted very well the questionnaire and found it useful to enhance communication with their patients (n= 8/10). Conclusions: The MTX Adherence Questionnaire is a patient self-administered tool that identifies patients facing adherence issues with MTX, and thereby helps clinicians make better-informed treatment decisions. It is suitable for use in clinical practice. A validation study to assess its robustness in research and clinical practice is being set up.
Dias-Barbosa, C., Guillemin, I., Aassi, M., Bernasconi, C., Brethous, M., Reiss, W., … Curtis, J. (2015). Methotrexate Adherence Questionnaire: a New Tool to Assess Adherence in Patients Treated with Methotrexate. Value in Health, 18(7), A714–A715. https://doi.org/10.1016/j.jval.2015.09.2697