Adherence to Subcutaneous Anti-Tumour Necrosis Factor Treatment in a Cohort of Patients with Rheumatoid Arthritis Before and After the Implementation of a Comprehensive Care Model

Pedro Santos-Moreno; Guillermo Sánchez-Vanegas; Angélica Monterrosa-Blanco; Gabriel-Santiago Rodríguez-Vargas; Manuel Rivero; Pedro Rodriguez; Omar-Javier Calixto; Adriana Rojas-Villarraga; Carlos Alberto Castro

doi:10.2147/BTT.S385422

Adherence to Subcutaneous Anti-Tumour Necrosis Factor Treatment in a Cohort of Patients with Rheumatoid Arthritis Before and After the Implementation of a Comprehensive Care Model

Biologics. 2022 Nov 21:16:199-209. doi: 10.2147/BTT.S385422. eCollection 2022.

Authors

Pedro Santos-Moreno¹, Guillermo Sánchez-Vanegas², Angélica Monterrosa-Blanco³, Gabriel-Santiago Rodríguez-Vargas¹, Manuel Rivero¹, Pedro Rodriguez¹, Omar-Javier Calixto⁴, Adriana Rojas-Villarraga⁵, Carlos Alberto Castro³

Affiliations

¹ Rheumatology Department, Biomab IPS, Bogotá, Colombia.
² Scientific Direction Department, Hospital Universitario Mayor Mederi, Universidad del Rosario, Bogotá, Colombia.
³ Research and Health Education Department, Comprehensive Solutions for Health Research and Education-SIIES, Bogotá, Colombia.
⁴ Rheumatology and Immunology Department, Hospital Militar Central, Bogotá, Colombia.
⁵ Research Institute, Fundación Universitaria de Ciencias de la Salud-FUCS, Bogotá, Colombia.

Abstract

Purpose: To assess, in a cohort of patients with rheumatoid arthritis (RA) treated with subcutaneous antitumor necrosis factor drugs (anti-TNFs), the levels of treatment adherence before and after implementing a comprehensive care model (CCM).

Patients and methods: An observational study including RA patients under treatment with subcutaneous anti-TNFs (adalimumab, etanercept, and golimumab) selected at convenience was performed; a sample size of 125 patients was calculated. The outcome variable was adherence assessed with the Compliance Questionnaire on Rheumatology (CQR19), measured before and after implementing a CCM. Descriptive and bivariate analyses were performed comparing adherence before and after applying the model (Wilcoxon and McNemar's Chi² test). For multivariate analysis, a generalized linear model adjusted for covariates was performed, where the difference in the proportion of adherence was the outcome measure.

Results: A total of 131 RA patients were followed-up for 24 months; average age was 62 years, and 83.9% were women. The median of DAS28 at the beginning of the follow-up was 2.32, and the HAQ was 0.25. At baseline, 87.8% were adherent; after 24 months, 96.2% were adherent according to CQR19. At the end of follow-up, adherence increased with the three types of anti-TNFs treatment. In a matched model adjusted for clinical variables, the CCM was estimated to produce a 9.4% increase in the total percentage of adherent patients. Additionally, a statistically significant increase of 4.5% in the percentage of adherent patients treated with golimumab compared with etanercept and adalimumab was found.

Conclusion: A CCM produced an important increase in the percentage of patients with rheumatoid arthritis adherent to treatment after 24 months of follow-up. It is noteworthy that Golimumab patients were more adherent when compared with other current anti-TNFs treatments.

Keywords: antirheumatic agents; comprehensive health care; controlled before–after studies; rheumatoid arthritis; treatment adherence.