Motivations for inadequate persistence with disease modifying anti-rheumatic drugs in early rheumatoid arthritis: the patient's perspective

Background: Knowledge of factors that contribute to non-persistence with disease modifying anti-rheumatic drugs (NP) is essential to improve rheumatoid arthritis (RA) outcomes. Aims of the study were to investigate patient's motivations and risk factors for NP in a cohort of early RA patients. Methods: Up to September 2012, data from 149 patients, who had at least 1 year of follow-up, at least one drug indication, and at least 2 consecutive six-months-apart rheumatic evaluations that included assessment of compliance were reviewed. NP and patient's motivations of NP were evaluated according to a questionnaire. NP was defined when patients referred that they had completely stop RA medication, Sometimes, Almost always or Always. Patients had to pay for their medication. Descriptive statistics and logistic regression models were used. Statistical significance was set at a p value of less than 0.05. The study was approved by the internal review board. Results: Up to cut-off, 715 questionnaires were applied to 149 patients, who had follow-up of 58.7 +/- 27.9 months and were indicated 2.4 +/- 0.7 DMARDs/patient/follow-up. Patients were most frequently female (88.6%), middle-aged ([mean +/- SD] age of 38.5 +/- 12.8 years) with lower-middle/lower socio-economic status (87.9%) and scholarship of 11 +/- 3.9 years. Ninety-nine (66.4%) patients were NP and filled 330 questionnaires. Multivariate analysis showed that years of formal education (OR: 1.12, 95% CI: 1.1-1.24, p = 0.03), perception of at least some difficulty to find arthritis medication (OR: 5.68, 95% CI: 2.48-13, p = 0.000) and perception that arthritis medication is expensive (OR: 5.27, 95% CI: 2.1-13.84, p = 0.001) at the first evaluation of patient's compliance were all predictors of NP. Among the 99 NP patients, 25 (25.3%) were recurrent-NP and accumulated more disease activity. The combination of both reasons of NP (Because it was not available at the drugstore and Because the medication is very expensive) when selected at the first evaluation of compliance was the only variable to predict recurrent NP, OR: 4.8, 95% CI: 1.1-20.8, p = 0.04. Conclusions: Health systems should provide (first line) treatment for RA as a strategy to improve compliance with therapy and clinical outcomes, particularly in vulnerable populations.