Patient Preference and Adherence (May 2021)
Electronic Monitoring Feedback for Improving Medication Adherence and Clinical Outcomes in Early Rheumatoid Arthritis: A Randomized Clinical Trial
Abstract
Milou van Heuckelum,1,2 Cornelia HM van den Ende,1,3 Sandra van Dulmen,4– 6 Bart JF van den Bemt2,7,8 1Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands; 2Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands; 3Department of Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands; 4Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands; 5Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; 6Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway; 7Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands; 8Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, the NetherlandsCorrespondence: Milou van HeuckelumDepartment of Rheumatology, Sint Maartenskliniek, PO Box 9011, Nijmegen, 9500 GM, the NetherlandsTel +31 24 352 8123Email [email protected]: Non-adherence to medication (range 30– 107%) is a major issue in patients with rheumatoid arthritis (RA). Previous research has shown that electronic monitoring feedback (EMF) might be an effective strategy to improve medication adherence in chronic conditions. Therefore, this study investigated the effectiveness of electronic monitoring feedback in patients with early RA to improve medication adherence and clinical outcomes compared to usual care.Methods: An open-label randomized clinical trial was performed to compare EMF with standard care during a 12-month follow-up period on two sites of the Sint Maartenskliniek (Nijmegen and Boxmeer) in the Netherlands. Patients were eligible if they: (1) had a (working) diagnosis of early RA, (2) were currently using methotrexate, (3) were aged ≥ 18 years, and (4) had a life expectancy of ≥ 12 months. Primary outcome was the difference in proportion of non-adherent patients measured with the Compliance Questionnaire on Rheumatology after 12 months. Secondary outcomes were beliefs about medicines, medication adherence measured with the MMAS-8®, patients’ health status, prescription of biologic DMARDs, and disease activity after 12 months.Results: Of the 367 initially-invited patients, 93 patients with early RA agreed to participate in this study. No significant difference was found in the proportion of non-adherent patients between the intervention arm and the usual care arm after 12 months follow-up (60.0% and 61.3%, p=0.93, respectively). Patients in the intervention arm tended to discontinue methotrexate earlier than patients in the usual care arm (median time in weeks: 15.7 (9.1– 33.6) and 21.9 (19– 28.4), respectively, p=0.31), whereas patients in the usual care arm tended to initiate biologic DMARDs earlier than those in the intervention arm (median time in weeks: 11.9 (5.7– 22) and 17 (9.9– 40.9), respectively, p=0.55).Conclusion: This study illustrates the challenge of targeting non-adherence with EMF in patients with early RA and shares important lessons learned about designing adherence intervention trials with respect to study attrition, accounting for drug survival, intervention fidelity, intervention uptake, and technical aspects.Keywords: randomized clinical trial, rheumatoid arthritis, DMARDs, medication adherence, disease activity, clinical outcomes
