Medication adherence and persistence of psoriatic arthritis patients treated with biological therapy in a specialty pharmacy in Brazil: a prospective observational study
Background: Pharmaceutical services in Brazil provide access, supply, and rational use of drugs for all population and an effort has been made to improve the quality of these services. Biological drugs are high-cost drugs supplied in Brazil that can inhibit disease progression and improve the quality of life of psoriatic arthritis (PsA) patients. However, some patients did not achieve therapeutic goals.
Objective: To evaluate the medication adherence and persistence of PsA patients treated with tumor necrosis factor inhibitors (anti-TNF) drugs and their associated factors.
Methods: A prospective observational study was performed at a single-specialty pharmacy in Belo Horizonte, Brazil. Medication adherence, persistence, and clinical outcomes were evaluated at 12 months of follow-up. Medication persistence was historically compared to overall PsA patients treated in Brazil. Associated factors were identified through log-binomial regression.
Results: One hundred ninety-seven PsA patients were included in the study, of whom 147 (74.6%) and 142 (72.1%) had medication adherence and persistence, respectively. Patients treated with infliximab presented the highest adherence (90.5%) and persistence rate (95.2%) in comparison to patients treated with other drugs, except for adalimumab versus infliximab for adherence outcome. All clinical measures significantly improved in patients with medication adherence and persistence. Medication persistence was higher for patients attended by specialty pharmacy than other PsA patients in Brazil. The associated factors to higher medication adherence were lower disease activity by BASDAI, being non-white race, and intravenous drug use. The associated factors to higher medication persistence were lower disease activity by Bath Ankylosing Spondylitis Activity Index (BASDAI), intravenous drug use, non-use of corticoids and non-steroidal anti-inflammatory drugs, and comorbidity.
Conclusions: Patients with medication adherence and persistence had significant improvements in clinical measures, functionality, and quality of life. High medication adherence and persistence to biological therapy were observed and associated with lesser disease activity at baseline. Also, medication persistence to PsA patients attended in specialty pharmacy was higher than the overall PsA population in Brazil, which indicates the importance of pharmaceutical services to provide health care and promote the effectiveness and safety of biological therapies.
Castro MC, Massuda A, Almeida G, et al. Brazil's unified health system: the first 30 years and prospects for the future. Lancet. 2019;394(10195):345-356. https://doi.org/10.1016/s0140-6736(19)31243-7
Vieira FS. Assistência farmacêutica no sistema público de saúde no Brasil [Pharmaceutical assistance in the Brazilian public health care system]. Rev Panam Salud Publica. 2010;27(2):149-156. https://doi.org/10.1590/s1020-49892010000200010
Correr CJ, Otuki MF, Soler O. Pharmaceutical services integrated into the healthcare process: clinical management of medicines. Revista Pan-Amazônica de Saúde, 2011;2(3):41-49. https://doi.org/10.5123/S2176-62232011000300006
Rover MRM, Peláez CMV, Faraco EB, Farias MR, Leite SN. An evaluation of governance capacity of the specialized component of pharmaceutical services in Brazil. Avaliação da capacidade de gestão do componente especializado da assistência farmacêutica. Cien Saude Colet. 2017;22(8):2487-2499. https://doi.org/10.1590/1413-81232017228.01602017
Lima-Dellamora Eda C, Caetano R, Osorio-de-Castro CG. [Dispensing specialized component medicines in areas of the State of Rio de Janeiro]. Cien Saude Colet. 2012;17(9):2387-2396. https://doi.org/10.1590/s1413-81232012000900019
da Silva MRR, Dos Santos JBR, Almeida AM, Alvares-Teodoro J, Kakehasi AM, Acurcio FA. Access to high-cost medications for psoriatic arthritis in the National Health System in Brazil: the long path up to dispensation. Adv Rheumatol. 2019;59(1):48. https://doi.org/10.1186/s42358-019-0091-7
Garcia MM, Guerra AA Júnior, Acúrcio FA. Economic evaluation of the Programs Rede Farmácia de Minas do SUS versus Farmácia Popular do Brasil. Cien Saude Colet. 2017;22(1):221-233. https://doi.org/10.1590/1413-81232017221.15912015
Minas Gerais State Health Secretariat. Pharmaceutical Services Superintendence. State plan for structuring the pharmaceutical services network: a strategy to expand access and rational use of medicines in SUS. https://www.saude.mg.gov.br/images/documentos/02%20Farmacia_de_Minas_050608.pdf (accessed Feb 1, 2021).
Coates LC, Helliwell PS. Psoriatic arthritis: state of the art review. Clin Med (Lond). 2017;17(1):65-70. https://doi.org/10.7861/clinmedicine.17-1-65
Belasco J, Wei N. Psoriatic Arthritis: What is Happening at the Joint?. Rheumatol Ther. 2019;6(3):305-315. https://doi.org/10.1007/s40744-019-0159-1
Haroon M, Gallagher P, FitzGerald O. Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis. Ann Rheum Dis. 2015;74(6):1045-1050. https://doi.org/10.1136/annrheumdis-2013-204858
Olivieri I, D'Angelo S, Palazzi C, Padula A, Lubrano E, Mantovani LG. Pharmacoeconomic issues in psoriatic arthritis. J Rheumatol Suppl. 2012;89:103-105. https://doi.org/10.3899/jrheum.120258
Boehncke WH, Qureshi A, Merola JF, et al. Diagnosing and treating psoriatic arthritis: an update. Br J Dermatol. 2014;170(4):772-786. https://doi.org/10.1111/bjd.12748
Lee S, Mendelsohn A, Sarnes E. The burden of psoriatic arthritis: a literature review from a global health systems perspective. P T. 2010;35(12):680-689.
Gossec L, de Wit M, Kiltz U, et al. A patient-derived and patient-reported outcome measure for assessing psoriatic arthritis: elaboration and preliminary validation of the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire, a 13-country EULAR initiative. Ann Rheum Dis. 2014;73(6):1012-1019. https://doi.org/10.1136/annrheumdis-2014-205207 .
Singh JA, Guyatt G, Ogdie A, et al. Special Article: 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis. Arthritis Care Res (Hoboken). 2019;71(1):2-29. https://doi.org/10.1002/acr.23789
da Silva MRR, Dos Santos JBR, Almeida AM, et al. Effectiveness and safety of anti-TNF in psoriatic arthritis patients in Brazil: a post-incorporation analysis. J Comp Eff Res. 2018;7(10):989-1000. https://doi.org/10.2217/cer-2018-0017
da Silva MRR, Dos Santos JBR, Almeida AM, Guerra Júnior AA, Alvares Teodoro J, Acurcio FA. Biological therapy in the treatment of psoriatic arthritis: economic and epidemiological considerations. Expert Rev Clin Immunol. 2019;15(8):879-887. https://doi.org/10.1080/1744666x.2019.1631798
Monaco C, Nanchahal J, Taylor P, Feldmann M. Anti-TNF therapy: past, present and future. Int Immunol. 2015;27(1):55-62. https://doi.org/10.1093/intimm/dxu102
Schwartzman S, Morgan GJ Jr. Does route of administration affect the outcome of TNF antagonist therapy?. Arthritis Res Ther. 2004;6 Suppl 2(Suppl 2):S19-S23. https://doi.org/10.1186/ar996
Murage MJ, Tongbram V, Feldman SR, et al. Medication adherence and persistence in patients with rheumatoid arthritis, psoriasis, and psoriatic arthritis: a systematic literature review. Patient Prefer Adherence. 2018;12:1483-1503. https://doi.org/10.2147/ppa.s167508
Bhoi P, Bessette L, Bell MJ, Tkaczyk C, Nantel F, Maslova K. Adherence and dosing interval of subcutaneous antitumour necrosis factor biologics among patients with inflammatory arthritis: analysis from a Canadian administrative database. BMJ Open. 2017;7(9):e015872. https://doi.org/10.1136/bmjopen-2017-015872
World Health Organization. Adherence to long-term therapies evidence for action. https://apps.who.int/iris/bitstream/handle/10665/42682/9241545992.pdf (accessed Feb 1, 2021).
Lima-Dellamora EDC, Osorio-de-Castro CGS, Madruga LGDSL, Azeredo TB. Use of pharmacy records to measure treatment adherence: a critical review of the literature. Cad Saude Publica. 2017;33(3):e00136216. https://doi.org/10.1590/0102-311x00136216
Andrade SE, Kahler KH, Frech F, Chan KA. Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf. 2006;15(8):565-577. https://doi.org/10.1002/pds.1230
Cramer JA, Roy A, Burrell A, et al. Medication compliance and persistence: terminology and definitions. Value Health. 2008;11(1):44-47. https://doi.org/10.1111/j.1524-4733.2007.00213.x
Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-497. https://doi.org/10.1056/nejmra050100
Taylor W, Gladman D, Helliwell P, et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006;54(8):2665-2673. https://doi.org/10.1002/art.21972
Orbai AM, Ogdie A. Patient-Reported Outcomes in Psoriatic Arthritis. Rheum Dis Clin North Am. 2016;42(2):265-283. https://doi.org/10.1016/j.rdc.2016.01.002
Peterson AM, Nau DP, Cramer JA, Benner J, Gwadry-Sridhar F, Nichol M. A checklist for medication compliance and persistence studies using retrospective databases. Value Health. 2007;10(1):3-12. https://doi.org/10.1111/j.1524-4733.2006.00139.x
National Committee for Health Technology Incorporation in the Unified Health System (Conitec). Approves the clinical protocol and therapeutic guidelines for psoriatic arthritis in Brazil. http://conitec.gov.br/images/Relatorios/2018/Relatorio_PCDT_ARTRITE_PSORIACA_2018.pdf (accessed Feb 1, 2021).
Borah BJ, Huang X, Zarotsky V, Globe D. Trends in RA patients' adherence to subcutaneous anti-TNF therapies and costs. Curr Med Res Opin. 2009;25(6):1365-1377. https://doi.org/10.1185/03007990902896386
Dabés CG, Almeida AM, Acurcio Fde A. [Non-adherence to biological therapy in patients with rheumatic diseases in the Brazilian Unified National Health System in Minas Gerais State, Brazil]. Cad Saude Publica. 2015;31(12):2599-2609. https://doi.org/10.1590/0102-311x00169514
Dos Santos JBR, Guerra Junior AA, da Silva MRR, Almeida AM, Acurcio FA, Alvares-Teodoro J. First line of biological drugs in rheumatoid arthritis: a medication persistence analysis. Expert Rev Clin Pharmacol. 2019;12(4):363-370. https://doi.org/10.1080/17512433.2019.1586533
Acurcio FA, Guerra Junior AA, da Silva MRR, et al. Comparative persistence of anti-tumor necrosis factor therapy in ankylosing spondylitis patients: a multicenter international study. Curr Med Res Opin. 2020;36(4):677-686. https://doi.org/10.1080/03007995.2020.1722945
Mongin D, Lauper K, Turesson C, et al. Imputing missing data of function and disease activity in rheumatoid arthritis registers: what is the best technique?. RMD Open. 2019;5(2):e000994. https://doi.org/10.1136/rmdopen-2019-000994
Oelke KR, Chambenoit O, Majjhoo AQ, Gray S, Higgins K, Hur P. Persistence and adherence of biologics in US patients with psoriatic arthritis: analyses from a claims database. J Comp Eff Res. 2019;8(8):607-621. https://doi.org/10.2217/cer-2019-0023
Santoleri F, Romagnoli A, Costantini A. Adalimumab and etanercept adherence, persistence and switch in the treatment of psoriatic arthritis: 10-year real-life analysis. Expert Opin Drug Saf. 2020;19(1):93-97. https://doi.org/10.1080/14740338.2020.1681396
Ribeiro da Silva MR, Ribeiro Dos Santos JB, Maciel Almeida A, et al. Medication persistence for psoriatic arthritis in a Brazilian real-world setting. Future Sci OA. 2019;5(2):FSO369. https://doi.org/10.4155/fsoa-2018-0101
Aaltonen K, Heinonen A, Joensuu J, et al. Effectiveness and drug survival of TNF-inhibitors in the treatment of psoriatic arthritis: A prospective cohort study. Semin Arthritis Rheum. 2017;46(6):732-739. https://doi.org/10.1016/j.semarthrit.2016.09.005
da Silva MRR, Dos Santos JBR, Almeida AM, Alvares-Teodoro J, Acurcio FA. Economic evaluation of adalimumab versus etanercept for psoriatic arthritis in a Brazilian real-world model [published online ahead of print, 2021 Feb 9]. Expert Rev Pharmacoecon Outcomes Res. 2021;1-7. https://doi.org/10.1080/14737167.2021.1880325
Bolge SC, Eldridge HM, Lofland JH, Ravin C, Hart PJ, Ingham MP. Patient experience with intravenous biologic therapies for ankylosing spondylitis, Crohn's disease, psoriatic arthritis, psoriasis, rheumatoid arthritis, and ulcerative colitis. Patient Prefer Adherence. 2017;11:661-669. https://doi.org/10.2147/ppa.s121032
López-González R, León L, Loza E, Redondo M, Garcia de Yébenes MJ, Carmona L. Adherence to biologic therapies and associated factors in rheumatoid arthritis, spondyloarthritis and psoriatic arthritis: a systematic literature review. Clin Exp Rheumatol. 2015;33(4):559-569.
Ogdie A, Coates LC, Gladman DD. Treatment guidelines in psoriatic arthritis. Rheumatology (Oxford). 2020;59(Suppl 1):i37-i46. https://doi.org/10.1093/rheumatology/kez383
Alves de Oliveira Junior H, Pereira da Veiga T, Acurcio FA, et al. Impact of biologic DMARDs on quality of life: 12-month results of a rheumatic diseases cohort using the Brazilian EQ-5D tariff. Hosp Pract (1995). 2020;48(4):213-222. https://doi.org/10.1080/21548331.2020.1785212
de Oliveira Junior HA, dos Santos JB, Acurcio FA, et al. Poorer functionality is related to better quality of life response following the use of biological drugs: 6-month outcomes in a prospective cohort from the Public Health System (Sistema Único de Saúde), Minas Gerais, Brazil. Expert Rev Pharmacoecon Outcomes Res. 2015;15(3):403-412. https://doi.org/10.1586/14737167.2015.1003367
Gast A, Mathes T. Medication adherence influencing factors-an (updated) overview of systematic reviews. Syst Rev. 2019;8(1):112. https://doi.org/10.1186/s13643-019-1014-8
Araújo PS, Costa EA, Guerra AA Junior, et al. Pharmaceutical care in Brazil's primary health care. Rev Saude Publica. 2017;51(suppl 2):6s. https://doi.org/10.11606/s1518-8787.2017051007109
Erku DA, Ayele AA, Mekuria AB, Belachew SA, Hailemeskel B, Tegegn HG. The impact of pharmacist-led medication therapy management on medication adherence in patients with type 2 diabetes mellitus: a randomized controlled study. Pharm Pract (Granada). 2017;15(3):1026. https://doi.org/10.18549/pharmpract.2017.03.1026
Xin C, Xia Z, Jiang C, Lin M, Li G. Effect of pharmaceutical care on medication adherence of patients newly prescribed insulin therapy: a randomized controlled study. Patient Prefer Adherence. 2015;9:797-802. https://doi.org/10.2147/ppa.s84411
Lavielle M, Puyraimond-Zemmour D, Romand X, et al. Methods to improve medication adherence in patients with chronic inflammatory rheumatic diseases: a systematic literature review. RMD Open. 2018;4(2):e000684. https://doi.org/10.1136/rmdopen-2018-000684
Joplin S, van der Zwan R, Joshua F, Wong PK. Medication adherence in patients with rheumatoid arthritis: the effect of patient education, health literacy, and musculoskeletal ultrasound. Biomed Res Int. 2015;2015:150658. https://doi.org/10.1155/2015/150658
Simpson RJ Jr. Challenges for improving medication adherence. JAMA. 2006;296(21):2614-2616. https://doi.org/10.1001/jama.296.21.jed60074
Copyright (c) 2021 The Authors
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.