Attitudes Affect Adherence to Inflammatory Disease Meds

Megan Brooks

June 18, 2014

PARIS — Patients' beliefs and concerns can influence how well they adhere to drug therapy for a range of chronic immune-mediated inflammatory diseases, a new study suggests.

"Accepting" patients who were not concerned about adverse effects were more apt to stick to their treatment than "ambivalent" patients who were concerned about adverse effects, the researchers report.

And the study hints that adherence is generally better in patients being treated with tumor necrosis factor (TNF) inhibitors than in those being treated with conventional therapy.

The results highlight the need for clinicians to "develop a better understanding of the ways their patients think about their treatment as a basis for understanding why they might not be showing optimal levels of adherence," said researcher John Weinman, PhD, professor of psychology at the Institute of Pharmaceutical Science, King's College, London, United Kingdom.

"This will provide them with a basis for working more closely with their patients to facilitate better use of medicines," he told Medscape Medical News.

Results from the ALIGN study were presented here at the European League Against Rheumatism Congress 2014.

ALIGN

The researchers evaluated the effect on adherence of beliefs, concerns, and attitudes about TNF inhibitors and selected conventional therapies, used either alone or in combination to treat rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, Crohn's disease, ulcerative colitis, and psoriasis.

Nearly 7200 patients from 33 countries completed validated questionnaires, including the Beliefs About Medicines Questionnaire (BMQ) and the short Morisky Medication Adherence Scale (MMAS-4). Mean age of the patients was 47.5 years, and mean disease duration was 11.7 years.

"The study was prompted by the need to conduct a truly multinational study of the role of illness and treatment beliefs in adherence to medication in patients with major inflammatory disorders," Dr. Weinman explained.

Overall, most patients were accepting of their medication, irrespective of their specific disease or treatment type.

For all treatment types, adherence to treatment was consistently lower in ambivalent patients than in accepting patients (46% - 69% vs 56% - 78%).

For all disease types, adherence to treatment was generally better in patients receiving anti-TNF therapy with or without conventional therapy (MMAS-4 score range, 3.4 - 3.7) than in those receiving conventional monotherapy (MMAS-4 score range, 2.6 - 3.3) or combination therapy (MMAS-4 score range, 2.8 - 3.4).

Being ambivalent about treatment "could negatively affect treatment efficacy," the researchers note. They suggest exploring patients' concerns about medication during routine consultations and addressing any erroneous beliefs about the benefits and risks of treatment as a means to "avoid potential nonadherence."

"We have just begun to explore the relation between medication beliefs and medication adherence, and we have found the expected relations between these," Dr. Weinman told Medscape Medical News. "Patients with higher medication concerns and lower necessity beliefs are significantly less adherent."

Who, What, and Why?

"It is important to understand the patients' concerns with medications, and the source of the concerns, which are not addressed in this abstract," said Eric Matteson, MD, chair of rheumatology at the Mayo Clinic in Rochester, Minnesota, who was not involved in the study.

The reasons for the ambivalence are not explored in this study, "nor are disease characteristics or patient characteristics, including male/female preferences, results by country, disease duration, or disease severity," he told Medscape Medical News.

Why patients might be more accepting of TNF inhibitors than conventional therapy is also not explored, Dr. Matteson pointed out.

"It may relate to convenience of administration and number of pills. It could also be that the TNF patients are more experienced, as these agents generally are used later in the disease course than anti-TNF agents," he said.

According to Dr. Weinman, the team "will soon be moving on to more fine-grained analyses of the results to examine whether there are any clear differences in patterns of adherence and patient beliefs across countries and in the main medical conditions and types of treatments investigated."

"This is a rich dataset, and many new insights will emerge," he said.

AbbVie funded the study and the analysis, and approved the abstract for submission. Several of the investigators report financial relationships with the company. Dr. Matteson has disclosed no relevant financial relationships.

European League Against Rheumatism (EULAR) Congress 2014: Abstract 0198. Presented June 11, 2014.

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