Assessing Methotrexate Adherence in Juvenile Idiopathic Arthritis Using Electronic Health Record-Linked Pharmacy...

Area of Science:

• Rheumatology
• Pharmacology
• Health Informatics

Background:

• Juvenile idiopathic arthritis (JIA) requires chronic medication management, often with methotrexate (MTX).
• Assessing medication adherence is crucial for treatment efficacy but can be challenging.
• Electronic health records (EHR) and pharmacy data offer potential for objective adherence measurement.

Purpose of the Study:

• To identify characteristics associated with MTX adherence in JIA patients.
• To determine the relationship between MTX adherence and JIA disease activity.

Main Methods:

• A retrospective cohort study of 224 JIA patients initiating MTX between 2016 and 2023.
• Adherence estimated using medication possession ratios (MPRs) from pharmacy dispensing data linked to EHR.
• Statistical analyses included bivariate comparisons and multivariable linear regression.

Main Results:

• 36.2% of patients were classified as nonadherent (MPR <80%).
• Younger age, Black race, and lower child opportunity index were associated with nonadherence.
• Adherent patients showed a statistically significant greater reduction in active joint count at 12 months compared to nonadherent patients.

Conclusions:

• Linking pharmacy and EHR data provides an objective method for assessing chronic medication adherence.
• Demographic and area-level factors influence MTX adherence in JIA.
• Adherence is associated with improved JIA disease activity, suggesting potential for intervention in socially disadvantaged populations.