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Background: Multiple factors may contribute to the development of difficult-to-treat rheumatoid arthritis (D2T-RA) including medication-taking behaviours 1. Non-adherence to medication is accompanied by poorer therapeutic response, which in turn can lead to subsequent drug discontinuation and frequent switching. Therefore, to maximize the therapeutic utility of biologic DMARDS (bDMARDs) before the onset of D2T disease, it is important to tackle the issue of non-adherence. Exploring the rates and reasons for non-adherence to bDMARDs in biologic-experienced RA patients is the first step in achieving this. Objectives: To assess the rates of non-adherence to bDMARDs in biologic-experienced RA patients via a systematic literature review Methods: We systematically searched six databases (Medline, PubMed, Embase, CINAHL, PsycINFO and Cochrane Library databases) spanning from 1990 to February 2022 for studies pertaining to RA and adherence to bDMARDs. In brief, studies were required to be observational and consist exclusively of bDMARD experienced (≥1 previous bDMARD) RA patients fulfilling 1987 ACR or 2010 ACR/EULAR classification criteria with available baseline characteristics. Subsequent study selection and extraction were performed independently by two authors. Results: A total of 1467 records were identified from the systematic search, of which 7 were eligible and available for extraction. Key adherence findings were summarized for biologic-experienced RA patients in Table 1. Three papers examined adherence to subcutaneous therapies, whilst intravenous or mixed methods of administration were explored in two papers each. Three studies assessed anti-TNF therapies and one study assessed tocilizumab. Abatacept was evaluated in three papers as part of the same observational study, with differing population cohorts. Adherence outcomes were displayed as retention/continuation rates in six studies, and drug implementation in one study. The overall retention/continuation rates to bDMARDs in biologic-experienced RA patients at one and two years ranged from 69.9% to 73.3% and 39.2% to 73% respectively. One study reported lower retention rates at three years with increased previous bDMARD exposure. Reasons for drug discontinuation were consistent between the studies and were commonly due to inefficacy or adverse events. Conclusion: This review supports that non-adherence to bDMARDs is common in biologic-experienced patients and with subsequent biologic therapies. Sustained non-adherence can undermine the full efficacious potential of bDMARDs. Our findings re-inforce the need to introduce and maintain interventions to diminish non-adherence specifically in the biologic experienced cohort. In turn, this could promote improved disease activity and delay the onset of difficult-to-treat disease. REFERENCES: 1 Roodenrijs NMT, van der Goes MC, Welsing PMJ, et al. Difficult-to-treat rheumatoid arthritis: contributing factors and burden of disease. Rheumatology (Oxford). 2021;60(8):3778-3788. doi:10.1093/rheumatology/keaa860. Acknowledgements: Evidence search: Jennifer Manders. (22nd February, 2022). BIRMINGHAM, UK: University Hospitals Birmingham (UHB) Library and Knowledge Service. Disclosure of Interests: None declared.
Singh et al. (Sat,) studied this question.