Electronic Monitoring Feedback for Improving Medication Adherence and Clinical Outcomes in Early Rheumatoid Arthritis: A Randomized Clinical Trial

Milou van Heuckelum; Cornelia H M van den Ende; Sandra van Dulmen; Bart J F van den Bemt

doi:10.2147/PPA.S297170

Electronic Monitoring Feedback for Improving Medication Adherence and Clinical Outcomes in Early Rheumatoid Arthritis: A Randomized Clinical Trial

Patient Prefer Adherence. 2021 May 25:15:1107-1119. doi: 10.2147/PPA.S297170. eCollection 2021.

Authors

Milou van Heuckelum^{1

2}, Cornelia H M van den Ende^{1

3}, Sandra van Dulmen^{4

5

6}, Bart J F van den Bemt^{2

7

8}

Affiliations

¹ Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands.
² Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands.
³ Department of Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands.
⁴ Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.
⁵ Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands.
⁶ Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
⁷ Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands.
⁸ Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, the Netherlands.

Abstract

Background: Non-adherence to medication (range 30-107%) is a major issue in patients with rheumatoid arthritis (RA). Previous research has shown that electronic monitoring feedback (EMF) might be an effective strategy to improve medication adherence in chronic conditions. Therefore, this study investigated the effectiveness of electronic monitoring feedback in patients with early RA to improve medication adherence and clinical outcomes compared to usual care.

Methods: An open-label randomized clinical trial was performed to compare EMF with standard care during a 12-month follow-up period on two sites of the Sint Maartenskliniek (Nijmegen and Boxmeer) in the Netherlands. Patients were eligible if they: (1) had a (working) diagnosis of early RA, (2) were currently using methotrexate, (3) were aged ≥18 years, and (4) had a life expectancy of ≥12 months. Primary outcome was the difference in proportion of non-adherent patients measured with the Compliance Questionnaire on Rheumatology after 12 months. Secondary outcomes were beliefs about medicines, medication adherence measured with the MMAS-8^®, patients' health status, prescription of biologic DMARDs, and disease activity after 12 months.

Results: Of the 367 initially-invited patients, 93 patients with early RA agreed to participate in this study. No significant difference was found in the proportion of non-adherent patients between the intervention arm and the usual care arm after 12 months follow-up (60.0% and 61.3%, p=0.93, respectively). Patients in the intervention arm tended to discontinue methotrexate earlier than patients in the usual care arm (median time in weeks: 15.7 (9.1-33.6) and 21.9 (19-28.4), respectively, p=0.31), whereas patients in the usual care arm tended to initiate biologic DMARDs earlier than those in the intervention arm (median time in weeks: 11.9 (5.7-22) and 17 (9.9-40.9), respectively, p=0.55).

Conclusion: This study illustrates the challenge of targeting non-adherence with EMF in patients with early RA and shares important lessons learned about designing adherence intervention trials with respect to study attrition, accounting for drug survival, intervention fidelity, intervention uptake, and technical aspects.

Keywords: DMARDs; clinical outcomes; disease activity; medication adherence; randomized clinical trial; rheumatoid arthritis.

Grants and funding

Research reported in this publication was supported by the Dutch Arthritis Foundation (Reumafonds). The Dutch Arthritis Foundation was not involved in the design of the study, data collection, analysis, interpretation of the data and in writing the manuscript.