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Agreement between Rheumatologist and Patient-reported Adherence to Methotrexate in a US Rheumatoid Arthritis

Jeffrey R Curtis1, Aseem Bharat2, Lang Chen2

  • 1From the University of Alabama at Birmingham, Birmingham, Alabama; Consortium of Rheumatology Researchers of North America (CORRONA) LLC, Southborough; University of Massachusetts, Worcester, Massachusetts, USA.J.R. Curtis, MD, MS, MPH, University of Alabama at Birmingham; A. Bharat, MD, MPH, University of Alabama at Birmingham; L. Chen, PhD, University of Alabama at Birmingham; J.D. Greenberg, MD, MPH, CORRONA LLC; L. Harrold, MD, MPH, University of Massachusetts; J.M. Kremer, MD, CORRONA LLC; T. Sommers, MS, CORRONA LLC; D. Pappas, MD, MPH, CORRONA LLC. jrcurtis@uabmc.edu.

The Journal of Rheumatology
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PubMed
Summary

Many rheumatologists overestimate methotrexate adherence in rheumatoid arthritis patients. A survey revealed that 13-20% of patients were misclassified, often due to missed doses rather than stopping medication.

Keywords:
ADHERENCEMETHOTREXATEPERSISTENCERHEUMATOID ARTHRITIS

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Area of Science:

  • Rheumatology
  • Pharmacology
  • Patient Adherence Research

Background:

  • Assessing medication adherence in rheumatology is challenging.
  • Methotrexate (MTX) is a cornerstone therapy for rheumatoid arthritis (RA).
  • The accuracy of rheumatologists' assessment of MTX adherence is not well-established.

Purpose of the Study:

  • To determine the extent to which rheumatologists overestimate methotrexate adherence in RA patients.
  • To compare patient self-reported adherence with clinician-reported MTX use.

Main Methods:

  • An internet survey was distributed to RA patients in a US registry.
  • Patient self-reported adherence was compared against MTX data recorded in the registry.
  • Response rate was 44%.

Main Results:

  • Of 228 patients reported by rheumatologists as taking MTX, 19.7% had discontinued or missed doses.
  • In a subgroup (n=149) with confirmed MTX use at the next visit, 13.3% reported missing at least one dose.
  • Methotrexate use was misclassified for 13%-20% of patients.

Conclusions:

  • A significant proportion of RA patients exhibit suboptimal methotrexate adherence.
  • Misclassification of MTX adherence is primarily due to missed doses, not overt discontinuation.
  • Clinicians need to be vigilant about suboptimal adherence when evaluating treatment response.