Adherence to Subcutaneous Anti-TNF Treatment in Chronic Inflammatory Rheumatism and Therapeutic Patient Education
Received 27 November 2019
Accepted for publication 28 January 2020
Published 24 February 2020 Volume 2020:14 Pages 363—369
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Johnny Chen
Françoise Fayet,1 Angélique Fan,1 Malory Rodere,1 Carine Savel,1 Bruno Pereira,2 Martin Soubrier1
1Rheumatology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; 2Biostatistics Unit, CHU Clermont-Ferrand, Clermont-Ferrand, France
Correspondence: Françoise Fayet
Rheumatology Department, CHU Clermont-Ferrand, Place Henri Dunant, Clermont-Ferrand 63000, France
Objective: Poor patient adherence to anti-TNF treatment has proven to be a major roadblock to effective management. Therapeutic patient education (TPE) is now recognized as a crucial tool in managing conditions like chronic inflammatory rheumatism and in improving treatment adherence. This study aimed to assess whether different TPE programs might improve adherence to subcutaneous anti-tumor necrosis factor (anti-TNF) treatment in patients with rheumatoid arthritis (RA), ankylosing spondyloarthritis (AS), and psoriatic arthritis (PsA).
Methods: This was a retrospective, observational, monocentric study of current care practices. We included 193 patients (124 women; mean age 53.3 ± 14.8 years). All patients received subcutaneous anti-TNF treatment and one of three TPE models, delivered by a nurse, from 2009 to 2013. The cohort was grouped according to different educational models: M1: information (N=92); M2: individual TPE (N=80); and M3: individual and group TPE sessions (N=21). Adherence was assessed with the Morisky Medication Adherence Scale (MMAS-4™). Scores were rated as follows: good adherence (MMAS-4 = 4), moderate adherence (MMAS-4 = 2– 3), and poor adherence (MMAS-4 = 0– 1).
Results: The mean disease duration was 10 years [95% CI: 5 to 18]. The cohort comprised 113 patients with RA, 73 with AS, and seven with PsA. Overall, 146 (75.7%) patients displayed good adherence, 34 (17.6%) displayed moderate adherence, and 13 (6.7%) displayed poor adherence. The M3 group displayed less adherence than the M1 and M2 groups. Old age was the only factor correlated with good adherence (p=0.005). The level of knowledge had no significant impact on adherence.
Conclusion: This study demonstrated good adherence to anti-TNF treatment in patients that received TPE, particularly when it was delivered in individual sessions.
Keywords: chronic inflammatory rheumatism, subcutaneous anti-TNF, treatment adherence, therapeutic education
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