AARDEX is collaborating with Pfizer to implement MEMS® in the FORWARD National Databank for Rheumatic Diseases to derive real world evidence adherence data.



To assess methotrexate (MTX) adherence
using the Medication Event Monitoring System (MEMS) and characterize
associations with adherence in patients with rheumatoid arthritis (RA).


Eligible patients participated in Forward,
the National Databank for Rheumatic Diseases, and recently (12 months or
sooner) initiated oral MTX. MEMS was used to compile MTX weekly dosing over 24
weeks. The Beliefs about Medicines Questionnaire (BMQ) was completed, and
baseline demographics and disease characteristics obtained. MTX adherence
(percentage of weeks dose taken correctly), implementation (percentage of weeks
dose taken correctly from initiation until last dose), and persistence
(duration from initiation to last dose) were calculated. Analyses measured
associations between patient characteristics and adherence, modeled using
logistic generalized estimating equations and censored Poisson regression, and
persistence modeled using Cox regression.


Overall, 60 of 119 eligible patients were
included in the analysis. MTX adherence, implementation, and persistence were
75%, 80%, and 83%, respectively, at 24 weeks. Demographics and disease
characteristics were generally similar between patients with 1 week or less and
2 weeks or more of missed MTX. Unemployment, less disability, higher Patient
Global scores, and no prior disease‐modifying antirheumatic drug (DMARD) use
were associated with correct dosing. No significant differences in adherence
were observed between patients receiving concomitant MTX versus MTX
monotherapy, and biologic DMARD‐experienced versus biologic DMARD‐naïve
patients. Higher scores in BMQ Specific Necessity (indicating a greater belief
in the necessity of the medication) was associated with a decreased likelihood
of dosing at an interval shorter than prescribed (odds ratio 0.89).

Conclusion Even in a participatory group over a short period, MTX adherence was suboptimal and associated with certain demographics, medication experience, and beliefs about medicines. This suggests a need for screening and alternative treatment opportunities in nonadherent MTX patients with RA.

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