Prevalence and Associated Factors for Non-adherence in Patients with Rheumatoid Arthritis

Dam Kim; Ji-Young Choi; Soo-Kyung Cho; Chan-Bum Choi; So-Young Bang; Hoon-Suk Cha; Jung-Yoon Choe; Won Tae Chung; Seung-Jae Hong; Tae-Hwan Kim; Tae-Jong Kim; Eunmi Koh; Hye-Soon Lee; Jisoo Lee; Shin-Seok Lee; Sung Won Lee; Sung-Hoon Park; Seung-Cheol Shim; Dae-Hyun Yoo; Bo Young Yoon; Sang-Cheol Bae; Yoon-Kyoung Sung

doi:10.4078/jrd.2018.25.1.47

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Kim, Choi, Cho, Choi, Bang, Cha, Choe, Chung, Hong, Kim, Kim, Koh, Lee, Lee, Lee, Lee, Park, Shim, Yoo, Yoon, Bae, and Sung: Prevalence and Associated Factors for Non-adherence in Patients with Rheumatoid Arthritis

Original Article

J Rheum Dis 2018;25(1):47-57.

Published online: 31 October 2018

DOI: https://doi.org/10.4078/jrd.2018.25.1.47

Prevalence and Associated Factors for Non-adherence in Patients with Rheumatoid Arthritis

Dam Kim^1,², Ji-Young Choi³, Soo-Kyung Cho^1,², Chan-Bum Choi^1,², So-Young Bang⁴, Hoon-Suk Cha⁵, Jung-Yoon Choe⁶, Won Tae Chung⁷, Seung-Jae Hong³, Tae-Hwan Kim¹, Tae-Jong Kim⁸, Eunmi Koh⁵, Hye-Soon Lee⁴, Jisoo Lee⁹, Shin-Seok Lee⁸, Sung Won Lee⁷, Sung-Hoon Park⁶, Seung-Cheol Shim¹⁰, Dae-Hyun Yoo¹, Bo Young Yoon¹¹, Sang-Cheol Bae^1,^2,^∗, Yoon-Kyoung Sung^1,^2,^∗

¹Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea

²Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea

³Kyung Hee University Medical Center, Seoul, Korea

⁴Hanyang University Guri Hospital, Guri, Korea

⁵Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

⁶Catholic University of Daegu School of Medicine, Daegu, Korea

⁷Dong-A University Hospital, Busan, Korea

⁸Chonnam National University Hospital, Gwangju, Korea

⁹Ewha Womans University Mokdong Hospital, Seoul, Korea

¹⁰Chungnam National University Hospital, Daejeon, Korea

¹¹Inje University Ilsan Paik Hospital, Goyang, Korea

Corresponding to: Yoon-Kyoung Sung, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea. E-mail: sungyk@hanyang.ac.kr Sang-Cheol Bae, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea. E-mail: scbae@hanyang.ac.kr

^* These authors contributed equally to this work.

Received 23 June 2017 Revised 22 September 2017 Accepted 17 October 2017

This is a Open Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

To estimate the prevalence of non-adherence to rheumatoid arthritis (RA) medication and identify the associated factors for non-adherence in RA patients.

Methods

Among the KORean Observational study Network for Arthritis 3,523 patients who completed a questionnaire about the adherence to RA medication were analyzed. The patients were divided into two groups: 1) adherent group, patients who skipped medication ≤5 days within the past 2 months; and 2) non-adherent group, patients who skipped ≥6 days of medication. The baseline characteristics were compared, and multivariable regression analysis was performed to identify the associated factors for non-adherence.

Results

The non-adherent group had 339 patients (9.6%). The common causes of non-adherence were forgetfulness (45.8%), absence of RA symptoms (24.7%), and discomfort with RA medication (13.1%). Younger age (odds ratio [OR] 1.02, p＜0.01) and higher income (OR 1.70, p＜0.01) were associated with an increased risk of non-adherence. Whereas higher functional disability (OR 0.68, p＜0.01) and oral corticosteroid use (OR 0.73, p=0.02) were associated with a decreased risk of non-adherence. The associated factors differed according to cause of non-adherence. Having adverse events (OR 2.65, p=0.02) was associated with the risk of non-adherence due to discomfort with RA medication while a higher level of education (OR 2.37, p=0.03) was associated with the risk of non-adherence due to an absence of RA symptoms.

Conclusion

The 9.6% of Korean RA patients were non-adherent to RA medication. The associated factors differed according to the cause of non-adherence. Therefore, an individualized approach will be needed to improve the adherence to RA medication.

Keywords: Medication adherence, Arthritis;rheumatoid, Prevalence

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Figure 1.

Patient selection flow chart. KORONA: KORean Observational study Network for Arthritis.

Figure 2.

Causes of non-adherence in rheumatoid arthritis (RA) patients.

Table 1.

Demographic and clinical characteristics of study patients

Variable	Total patients (n=3,523)	Non-adherent group (n=339)	Adherent group (n=3,184)	p-value
Age (yr)	54.2±11.8	50.9±12.6	54.6±11.7	＜0.01
Disease duration (yr)	8.6±7.6	8.5±6.8	8.6±7.6	0.82
Female sex	3,020 (85.7)	303 (89.4)	2,717 (85.3)	0.052
Income (US dollars/mo)				＜0.01
＜2,000	1,719 (49.0)	139 (41.1)	1,580 (49.8)
2,000∼4,990	1,394 (39.7)	143 (42.3)	1,251 (39.5)
≥5,000	395 (11.3)	56 (16.6)	339 (10.7)
Education				0.10
Middle school or less	1,601 (45.7)	140 (41.3)	1,461 (46.1)
High school or more	1,906 (54.3)	199 (58.7)	1,707 (53.9)
Adverse events	1,210 (34.3)	150 (44.2)	1,060 (33.3)	＜0.01
DAS28-ESR	3.7±1.3	3.8±1.3	3.7±1.3	0.46
HAQ	0.67±0.64	0.57±0.57	0.68±0.65	＜0.01
ESR	29.3±23.8	30.4±24.3	29.1±23.8	0.41
CRP	0.7±1.2	0.6±1.2	0.7±1.2	0.19
Comorbidities
Cardiovascular disease	127 (3.6)	11 (3.2)	116 (3.6)	0.83
Hypertension	893 (25.3)	67 (19.8)	826 (25.9)	0.02
Pulmonary disease	326 (9.3)	29 (8.6)	297 (9.3)	0.71
Gastrointestinal disease	786 (22.3)	84 (24.8)	702 (22.0)	0.28
Hepatic disease	180 (5.1)	21 (6.2)	159 (5.0)	0.41
Renal disease	90 (2.6)	12 (3.5)	78 (2.4)	0.30
Diabetes mellitus	284 (8.1)	12 (3.5)	272 (8.5)	＜0.01
Depression	56 (1.6)	10 (2.9)	46 (1.4)	0.06
Malignancy	102 (2.9)	10 (2.9)	92 (2.9)	1.00
Medication
Methotrexate	2,935 (83.3)	286 (84.4)	2,649 (83.2)	0.64
Other DMARDs	2,755 (78.3)	266 (78.5)	2,489 (78.2)	0.99
NSAIDs/painkiller	2,840 (80.6)	275 (81.1)	2,565 (80.6)	0.86
Oral corticosteroid	2,594 (73.6)	233 (68.7)	2,361 (74.2)	0.04
Biologic agents	209 (5.9)	11 (3.2)	198 (6.2)	0.04
Anti-osteoporotic agents	843 (23.9)	69 (20.4)	774 (24.3)	0.12
Number of daily medications	2.6±1.0	2.6±1.0	2.7±1.0	0.14
Number of weekly medications	0.9±0.5	0.9±0.5	0.9±0.5	0.51
Dietary supplements	1,646 (46.7)	164 (48.4)	1,482 (46.6)	0.56

Values are presented as mean±standard deviation or number (%), and bold value indicates statistical significance at the 0.05 level. DAS28-ESR: disease activity score 28 joints-erythrocyte sedimentation rate, HAQ: health assessment questionnaire, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein, DMARDs: disease modifying antirheumatic drugs, NSAIDs: non-steroidal anti-inflammatory drugs.

Table 2.

Associated factors for non-adherence in RA patients

Variable	Crude		Multivariable (1)		Multivariable (2)
Variable	OR (95% CI)	p-value	OR (95% CI)	p-value	OR (95% CI)	p-value
Younger age (yr)	1.03 (1.02∼1.04)	＜0.01	1.02 (1.01∼1.04)	＜0.01	1.02 (1.01∼1.04)	＜0.01
Disease duration (yr)	1.00 (0.98∼1.01)	0.82
Female sex	1.45 (1.01∼2.07)	0.04	1.27 (0.84∼1.91)	0.25	1.25 (0.83∼1.88)	0.29
Income (US dollars/mo)
＜2,000	Reference		Reference		Reference
2,000∼4,990	1.30 (1.02∼1.66)	0.04	1.16 (0.87∼1.56)	0.31	1.15 (0.86∼1.55)	0.34
≥5,000	1.88 (1.35∼2.62)	＜0.01	1.70 (1.15∼2.52)	＜0.01	1.71 (1.16∼2.52)	＜0.01
Education
Middle school or less	Reference		Reference		Reference
High school or more	1.22 (0.97∼1.53)	0.09	0.73 (0.53∼1.01)	0.054	0.72 (0.53∼0.997)	) 0.048
Adverse events	1.59 (1.27∼2.00)	＜0.01	1.78 (1.38∼2.29)	＜0.01
Gastrointestinal adverse events	1.72 (1.36∼2.17)	＜0.01			1.83 (1.40∼2.38)	＜0.01
Dermatologic adverse events	1.39 (0.97∼1.98)	0.07			1.28 (0.88∼1.88)	0.2
Other adverse events	0.67 (0.43∼1.03)	0.07			1.35 (0.84∼2.15)	0.21
DAS28-ESR	1.04 (0.95∼1.13)	0.46	1.13 (1.01∼1.27)	0.03	1.13 (1.01∼1.26)	0.04
HAQ	0.75 (0.62∼0.91)	＜0.01	0.68 (0.52∼0.88)	＜0.01	0.67 (0.52∼0.87)	＜0.01
ESR	1.00 (1.00∼1.01)	0.41
CRP	0.93 (0.83∼1.04)	0.20
Comorbidities
Cardiovascular disease	0.89 (0.47∼1.66)	0.71
Hypertension	0.70 (0.53∼0.93)	0.01	0.97 (0.70∼1.34)	0.83	0.97 (0.70∼1.35)	0.87
Pulmonary disease	0.91 (0.61∼1.36)	0.64
Gastrointestinal disease	1.17 (0.90∼1.51)	0.25	1.01 (0.75∼1.35)	0.96	0.98 (0.73∼1.32)	0.88
Hepatic disease	1.26 (0.79∼2.01)	0.34
Renal disease	1.46 (0.79∼2.71)	0.23
Diabetes mellitus	0.39 (0.22∼0.71)	＜0.01	0.51 (0.27∼0.99)	0.048	0.51 (0.27∼0.99)	0.048
Depression	2.07 (1.04∼4.15)	0.04	2.02 (0.95∼4.26)	0.07	1.95 (0.92∼4.14)	0.08
Malignancy	1.02 (0.53∼1.98)	0.95
Medication
Methotrexate	1.09 (0.80∼1.48)	0.58
Other DMARDs	1.01 (0.77∼1.33)	0.93
NSAIDs/painkiller	1.04 (0.78∼1.38)	0.80	1.21 (0.87∼1.69)	0.25	1.21 (0.87∼1.69)	0.26
Oral corticosteroid	0.77 (0.60∼0.98)	0.03	0.73 (0.55∼0.96)	0.02	0.73 (0.55∼0.96)	0.02
Biologic agents	0.51 (0.27∼0.94)	0.03	0.54 (0.29∼1.02)	0.06	0.53 (0.28∼1.00)	0.051
Anti-osteoporotic agents	0.80 (0.60∼1.05)	0.11
Number of daily medications	0.92 (0.83∼1.03)	0.15
Number of weekly medications	0.93 (0.74∼1.16)	0.51
Dietary supplements	1.08 (0.86∼1.35)	0.52

Values are presented as mean±standard deviation or number (%), and bold value indicates statistical significance at the 0.05 level. RA: rheumatoid arthritis, OR: odds ratio, CI: confidence interval, DAS28-ESR: disease activity score 28 joints-erythrocyte sedimentation rate, HAQ: health assessment questionnaire, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein, DMARDs: disease modifying antirheumatic drugs, NSAI IDs: non-steroidal anti-inflammatory drugs.

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