Recommendations for the assessment and optimization of adherence to disease-modifying drugs in chronic inflammatory rheumatic diseases: A process based on literature reviews and expert consensus

Laure Gossec (1, 2, 3, 1) , Anna Moltó (4, 5) , Xavier Romand (6, 7, 8) , Déborah Puyraimond-Zemmour (3, 1, 1, 2) , Matthieu Lavielle (4, 5) , Catherine Beauvais (9) , Eric Senbel , René-Marc Flipo (10, 11) , Sophie Pouplin (12) , Christophe Richez (13) , Alain Saraux (14, 15) , Maryse Mezieres (16, 5) , Loriane Gutermann (4, 5) , Philippe Gaudin (7, 6, 8) , Daniel Wendling (17, 18, 19, 20) , Maxime Dougados (16, 5)

1 CHU Pitié-Salpêtrière [AP-HP]
2 SU - Sorbonne Université
3 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
4 Hôpital Cochin [AP-HP]
5 CRESS (U1153 / UMR_A_1125 / UMR_S_1153) - Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité
6 UGA UFRM - Université Grenoble Alpes - UFR Médecine
7 Service de Rhumatologie [CHU de Grenoble]
8 GREPI - Groupe de Recherche et d'Etude du Processus Inflammatoire
9 CHU Saint-Antoine [AP-HP]
10 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
11 Service de rhumatologie[Lille]
12 CHU Rouen
13 CHU Bordeaux
14 CHU - BREST - Hôpital de la Cavale Blanche - CHRU Brest
15 UBO UFR MSS - Université de Bretagne Occidentale - UFR Médecine et Sciences de la Santé
16 Service de rhumatologie [CHU Cochin]
17 Service de Rhumatologie
18 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
19 EPILAB - Epigénétique des infections virales et des maladies inflammatoires (UR 4266)
20 UFC - Université de Franche-Comté

BACKGROUND: Adherence to treatment is a key issue in chronic inflammatory rheumatic diseases (CIRDs). OBJECTIVE: To develop recommendations to facilitate in daily practice, the management of non-adherence to disease-modifying drugs in patients with rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, connective tissue diseases or other CIRDs. METHODS: The process comprised (a) systematic literature reviews of methods (including questionnaires) to measure non-adherence, risk factors for non-adherence and efficacy of targeted interventions; (b) development of recommendations through consensus of 104 rheumatologist and nurse experts; (c) assessment of agreement and ease of applicability (1-5 where 5 is highest) by the 104 experts. RESULTS: (a) Overall, 274 publications were analysed. (b) The consensus process led to 5 overarching principles and 10 recommendations regarding adherence. Key points include that adherence should be assessed at each outpatient visit, at least using an open question; questionnaires and hydroxychloroquine blood level assessments may also be useful. Risk factors associated to non-adherence were listed. Patient information and education, and patient/physician shared decision, are key to optimize adherence. Other techniques such as formalized education sessions, motivational interviewing and cognitive behavioral therapy may be useful. All health professionals can get involved and e-health may be a support. (c) The agreement with the recommendations was high (range of means, 3.9-4.5) but ease of applicability was lower (2.7-4.4). CONCLUSIONS: Using an evidence-based approach followed by expert consensus, this initiative should improve the assessment and optimization of adherence in chronic inflammatory rheumatic disorders.

Mots clés: Adherence; Compliance; Recommendations; Rheumatoid arthritis; Spondyloarthritis

Domaines: Sciences du Vivant [q-bio]; Rhumatologie et système ostéo-articulaire

Laure Gossec, Anna Moltó, Xavier Romand, Déborah Puyraimond-Zemmour, Matthieu Lavielle, et al.. Recommendations for the assessment and optimization of adherence to disease-modifying drugs in chronic inflammatory rheumatic diseases: A process based on literature reviews and expert consensus. Joint Bone Spine, 2019, 86 (1), pp.13-19. ⟨10.1016/j.jbspin.2018.08.006⟩. ⟨hal-02171141⟩