DiBenedetti DB, Zhou X, Reynolds M, Ogale S, Best JH. Assessing methotrexate adherence in rheumatoid arthritis: a cross-sectional survey. Rheum Ther. 2015 May 13;2(1):73-84. doi: 10.1007/s40744-015-0011-1

Introduction: Limited data are available to explain nonadherence to methotrexate (MTX) therapy in patients with rheumatoid arthritis (RA). Better understanding of patterns of MTX use and reasons for nonadherence may help identify patients who would benefit from alternative RA treatments and potentially aid in developing strategies to increase overall adherence. The purpose of this study was to assess patients’ self-reported adherence to MTX and to identify reasons for nonadherence.

Methods: Patient panel members in the US self-reporting a diagnosis of RA of ≥3 months’ and current MTX use of ≥4 weeks’ duration, with or without concomitant use of another RA prescription medication, participated in this cross-sectional, web-based survey.

Results: The sample population (251 MTX monotherapy, 250 MTX combination therapy) was predominantly female, white, non-Hispanic, and educated; 48% were 18–44 years-old, 47% had medical comorbidities, 66% were first diagnosed with RA ≤5 years earlier, 51% reported MTX use of <1 year, and 83% reported oral MTX use. Forty-two percent reported not taking MTX exactly as prescribed. Reasons for nonadherence included forgetting to take it (33%), not needing it when feeling well (24%), and concern about long-term safety (24%). Among nonadherent patients, 53% took smaller doses, 52% skipped doses, and 6% reported other nonprescribed ways of taking MTX. Younger age, male sex, and shorter duration of MTX use were associated with poorer self-reported adherence. Compared with monotherapy patients, combination therapy patients, particularly those taking ≥2 other RA prescriptions, were less likely to report high adherence.

Conclusion: Nearly half the sample reported poor MTX adherence because they forgot to take it, thought it was not needed when they felt well, or had long-term safety concerns. Patients taking ≥2 other RA prescription medications were less likely to report good adherence. Reducing treatment burden without sacrificing efficacy may be a strategy worth evaluating.

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