ADHERENCE TO MTX AT INITIATION OF FIRST TARGETED THERAPY (PREVALENCE AND ASSOCIATED FACTORS): RESULTS OF THE STRATEGE2 STUDY.

Background: Treatment adherence is a major challenge in chronic inflammatory rheumatic disease (CIRD). Mainly studied in rheumatoid arthritis (RA), this ranges from 30 to 80% [1]. Given the impact of non-adherence to disease-modifying therapy among RA patients, guidelines aiming to facilitate management of adherence were published in 2019 [2]. These guidelines highlight the multifactorial characteristics and importance of clarifying the factors determining non-adherence. In addition, treatment adherence was also listed as a point to consider for the management of difficult-to-treat RA by an EULAR task force [3]. Objectives: Based on inclusion results of STRATEGE 2 we explore the adherence to methotrexate (MTX) and its associated factors prior to initiation of a first targeted therapy. Methods: The objective of STRATEGE2 is to describe the therapeutic strategy in RA patients treated with MTX for at least 3 months, naive of targeted biological (bDMARD) or synthetic (tsDMARD) therapy and who are candidates for initiation of first b/tsDMARD therapy due to RA activity. Patients were included prospectively in 2019-2020 and completed the Compliance Questionnaire for Rheumatology (CQR) [4], a self-administered questionnaire specific to rheumatology, measuring treatment adherence. They were then divided into 2 groups: adherence (Ad) (CQR19>80) vs. non-adherence (NAd) to investigate factors liable to be associated with adherence. Then, univariate and multivariate analysis was applied to identify potential predictors for adherence. Results: Between Feb. 2019 and Dec. 2020, 230 patients were included, with 124 RA patients having an analysable CQR19: 73.4% females, mean age 56.6 years (±13.2), diagnosed 5.6 years (±7.4) previously, treatment with MTX for 4.4 years (±5.3) and a mean DAS of 4.3 (±1.2). The mean CQR score was 75.8. Patient distribution: 45.2% in the Ad group and 54.8% in the NAd group. Table 1. At baseline (before b/tsDMARD initiation) Ad - N=56 NAd - N=68 p Sex: female 73.2% 73.5% - Age (mean) 59.3 (±13.6) 54.4 (±12.4) p < 0.05 BMI (mean) 27.2 (±7.0) 25.0 (±4.7) p < 0.15 Still in work 39.3% 55.9% p < 0.15 At least 1 comorbidity 60.7% 47.1% p < 0.15 Positive anti-CCP 67.9% 80.6% p < 0.15 Positive rheumatoid factor 69.8% 84.8% p < 0.05 Radiological signs 57.1% 41.8% p < 0.15 RA duration (years) 4.9 ±6.7 6.3 ±8.0 - Average MTX initiation (years) 4.0 ±4.7 4.8 ±5.7 - Per os MTX 28.6% 29.4% - → mean dosage (mg/week) 16.4 ±4.5 15.6 ±4.6 Subcutaneous MTX 69.6% 70.6% - → mean dosage (mg/week) 20.1 ±4.6 19.4 ±3.3 - Intramuscular MTX 1.8% 0% - Patients self-administration 30.0% 12.5% P < 0.05 Corticosteroid therapy 53% 50.6% - → mean dosage (mg/day) 8.1 ±4.1 9.5 ±5.8 Mean DAS28 4.5 ± 1.3 4.2 ±1.2 - Mean HAQ 1.1 ± 0.7 0.9 ±0.7 p < 0.15 In the multivariate analysis, no formal predictive factors to MTX adherence was identified except BMI>30kg/m (odds ratio, OR (95% confidence interval, CI)=4.00, 1.08-14.86, p=0,038) and adherents who estimate having completely participate to the decision-making for the targeted therapy (OR (95% CI)=6.41, 2.32-17.65, p<0.001). Conclusion: In this cohort, beyond the recently published guidelines, nearly half of patients do not show adherence to MTX (CQR19-based evaluation) before initiation of b/tsDMARD. As physicians tend to overestimate adherence to medication, clarification of the factors associated with non-adherence would help improve patient assessment and, therefore, management. Supplementary data on patients’ adherence evolution and adherence predictors, might be observed on the follow-up data at 12 and 24 months of this cohort. REFERENCES: [1]Beauvais C, et al. Joint Bone Spine 2020;87(6):668-669. [2]Gossec C, et al. Joint Bone Spine 2019;86(1):13-19. [3]Nagy G, et al. Ann Rheum Dis 2021; 0 :1–14. [4]De Klerk E, et al . J Rheumatol 2003;30(11):2469-2475 Acknowledgements: The authors wish to acknowledge RCTs for their contribution to the statistical analysis, the investigators, centres and patients. Disclosure of Interests: Cécile Gaujoux-Viala Speakers bureau: AbbVie; Amgen; Boehringer Ingelheim, Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences, Inc.; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; and UCB, Consultant of: AbbVie; Amgen; Boehringer Ingelheim, Bristol-Myers Squibb; Celgene; Eli Lilly; Galapagos; Gilead Sciences, Inc.; Janssen; Medac; Merck-Serono; Mylan; Nordic Pharma; Novartis; Pfizer; Roche; Sandoz; Sanofi; and UCB, Emmanuelle Dernis Speakers bureau: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, MSD, Nordic Pharma, Roche-Chugaï Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos, Gilead, Janssen, MSD, Nordic Pharma, Roche-Chugaï Novartis, Pfizer, Roche, Sandoz, Sanofi and UCB Pharma., Eric Senbel Speakers bureau: AbbVie, Amgen, Biogen, Janssen, Lilly, MSD, Nordic Pharma, Pfizer Roche-Chugai and Sandoz, Sanofi., Consultant of: AbbVie, Amgen, Biogen, Janssen, Lilly, MSD, Nordic Pharma, Pfizer Roche-Chugai and Sandoz, Sanofi., Hélène Herman-Demars Employee of: Nordic Pharma France, Jennifer Becker Employee of: Nordic Pharma France, René-Marc Flipo Speakers bureau: Abbvie, Bristol-Myers Squibb, Eli-Lilly, Janssen, Medac, MSD, Nordic-Pharma, Novartis, Pfizer, Roche-Chugaï, and Sanofi., Consultant of: Abbvie, Bristol-Myers Squibb, Eli-Lilly, Janssen, Medac, MSD, Nordic-Pharma, Novartis, Pfizer, Roche-Chugaï, and Sanofi. Citation: , volume 81, supplement 1, year 2022, page 1830Session: Epidemiology, risk factors for disease or disease progression (Publication Only)