Assessment of treatment adherence in rheumatoid arthritis italian patients using a validated version of the 5-item compliance questionnaire for rheumatology (I-CQR5)

Background: The 5-item Compliance Questionnaire for Rheumatology (CQR5) allows the identification of patients likely to be high adherers (HA) to anti-rheumatic treatment (i.e. taking ≥80% of their medications correctly), or “low” adherers (LA). We have previously validated an Italian version of the questionnaire (I-CQR5) following standardised guidelines. Objectives: The objective was to investigate what factors are associated with high treatment adherence according to I-CQR5 in RA. Methods: RA patients (disease duration >1 year, undergoing treatment with ≥1 self-administered biological or conventional synthetic disease-modifying anti-rheumatic drugs (bDMARDs, csDMARDs), capable of completing the questionnaire unaided) completed I-CQR5 on one occasion. I-CQR5 were anonymous and clinical data were retrieved anonymously from the local database. To investigate what factors were associated with high adherence, we included demographic and social characteristics, clinical and treatment information. Factors achieving a p<0.10 in univariate analysis were included in the multivariate regression analysis. Results: Among 604 RA patients, 328 patients were enrolled, 18 questionnaires were incomplete. Median age of the patients was 57 years, females were 232 (82%), disease duration was 12 years; 193 (64.3%) patients were treated with bDMARDs and 107 (54.6%) with csDMARD only; 270 (90.3%) were in low disease activity or remission (figure 1). HA were found to be 35.2% (109/310) of the patients.40.2% (79/193) were on bDMARDs and 22.4% (24/107) on csDMARDs. Older age, lower education level, higher prednisone daily dose, use of a csDMARD (particulary hydroxychloroquine and sulfasalazine) and higher patient-VAS were significantly more frequent in LA compared with HA (figure 1). In the multivariate analysis, bDMARD treatment and employment resulted independently associated with high adherence: OR 2.88 (1.36–6.1), p=0.006 and OR 2.36 (1.21–4.62), p=0.012 respectively (table 1). Abstract AB0286 – Table 1 Factors associated with high adherence to anti-rheumatic treatment defined by I-CQR5: a multivariate regression analysis model OR (95% C.I.) p value Female gender 0.79 (1.58–0.39) 0.501 Employment 2.36 (1.21–4.62) 0.012 bDMARD treatment 2.88 (1.36–6.1) 0.006 Patient-VAS (per 10-unit increase) 0.88 (0.78–1) 0.052 Model constant <0.001 OR odds ratio, C.I. confidence interval, bDMARD biological DMARD, DMARD disease-modifying anti-rheumatic drug, VAS visual analogic scale. Abstract AB0286 – Table 2 Demographics and clinical variables according to high and low adherence to treatment defined by I-CQR5. defined as DAS28 <2.6; defined as DAS28 <3.2; variables included in the multivariate analysis as achieving a p value<0.10 in the univariate analysis. HA high adherers, LA low adherers, IQR interquartile range, BMI body mass index, ACPA anti-citrullinated peptides, RF rheumatoid factor, csDMARD conventional synthetic DMARD, bDMARD biological DMARD, DMARD disease-modifying anti-rheumatic drug, PDN prednisone, NSAIDs non-steroideal antinflammatory drugs, HAQ Health Assessment Questionnaire, DAS28 disease activity score in 28 joints, VAS visual analogic scale. Conclusions: Only one third of Italian RA patients were highly adherent to treatment according to I-CQR5. Treatment with bDMARDs and employment status were the major determinants of treatment adherence, increasing by almost 3-fold the likelihood of being highly adherent. Reference: Hughes L, et al. A 5 item version of the Compliance Questionnaire for Rheumatology (CQR5) successfully identifies low adherence to DMARDs. BMC Musculoskelet Disord 2013;14:286. Disclosure of Interest: None declared DOI: 10.1136/annrheumdis-2018-eular.4294 Citation: Ann Rheum Dis, volume 77, supplement Suppl, year 2018, page A1322Session: Rheumatoid arthritis – prognosis, predictors and outcome