7/29/2019 Research Project Poster MCrowe FINAL

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Objective

To determine the correlation between medication

adherence to biologic therapy and patient-reported

measures of disease activity, after the initiation of

therapy in patients with RA, receiving care from this

community-based specialty pharmacy.

The Correlation Between Medication Adherence and Disease Activity in Adult Patients

with Rheumatoid Arthritis Receiving Care at a Specialty PharmacyMichael W. Crowe1, Ho-Cheong S. Lee2, Heidi M. Michels1, Chris Y. Baek1, Mark S. Chaffee1

1Diplomat Specialty Pharmacy, Grand Rapids, MI; 2Ferris State University, Grand Rapids, MI

PatientsBackground

Methods

In patients with rheumatoid arthritis (RA),

non-adherence to and non-persistence with disease

modifying antirheumatic drugs (DMARDs) is prevalent

(20-70%).1

Low adherence results in poor health outcomes, improper

assessment of efficacy, and increased healthcare costs. It

also contributes to treatment failure, delayed disease

recovery, accelerated disease progression, and the need

for more aggressive treatment. Treatment failure rates

are lower in patients with higher adherence.2-5

Improved adherence has been demonstrated in patients

with RA receiving:

Satisfactory contact with healthcare professionals6

Disease and treatment education6

Pharmacist interventions, such as telephone calls, to

discuss adherence or medication-related problems7

Diplomat Specialty Pharmacy has previously established a

drug therapy management program (DTM) for patients

with RA.

Eligibility Criteria

1. Patient > 18 years of age diagnosed with RA

2. Receive FDA-approved doses of either adalimumab or

etanercept, for the treatment of RA, for > 12 months

from this specialty pharmacy

3. Competent (i.e. responsible for their own healthcare)

4. No record of receiving previous biologic DMARD therapy

within 4 weeks of enrollment into the DTM program

5. Enrolled between June 1, 2008 and February 28, 2010

6. No biologic-free periods lasting greater than 4 weeks

7. At least 1 score available for each survey (HAQ-II, NRS)

Exclusion Summary

284 patients met eligibility criteria 1 through 5 above.

87 were excluded for having a drug-free period > 4 weeks.

107 were excluded for missing outcomes data.

Patients Eligible for Evaluation

Indicates patients that switched from adalimumab to

etanercept (or vice versa), during their enrollment period

Overall

(n = 90)

Adalimumab

(n = 30)

Etanercept

(n = 54)

Switched

(n = 6)

Mean Age

(range)

54

(20-75)

52

(51-75)

56

(30-73)

46

(20-69)

% Female 70% 60% 72% 100%

Results

Discussion Conclusions

References

1. Pascual-Ramos V, Contreras-YanezI, Villa AR, et al. Medicationpersistence over 2 yearsof follow-upin acohort of early rheuma

arthritis patients: associatedfactorsandrelationshipwithdisease activity andwithdisability. Arthritis Res Ther. 2009;11(1):R26

2. HaynesR, AcklooE, SahotaN, et al. Interventionsfor enhancingmedicationadherence.Cochrane Database Syst Rev 2008,Issue

Art.No.:CD000011.

3. Osterberg L, Blaschke T. Adherence tomedication.N Engl J Med. 2005;353:487-97.

4. GrijalvaC, Chung C, Arbogast P, et al. Assessment of adherence toandpersistence ondisease-modifyingantirheumaticdrugs(D

patientswithrheumatoidarthritis. MedCare.2007;45(10):S66-76.

5. Fernandez-NebroA, IrigoyenMV, UrenaI, et al. Effectiveness, predictive response factors, andsafety of anti-tumor necrosisfac

therapiesinanti-TNF-nave rheumatoidarthritis. J Rheumatol. 2007;34(12):2334.

6. Viller F, GuilleminF, BrianconS, et al. Compliance todrugtreatment of patientswithrheumatoidarthritis:a3 year longitudina

Rheumatol. 1999;26:2114-22.

7. CliffordS, Barber N, Elliot R, et al. Patient-centeredadviceiseffective inimprovingadherence tomedicines. PharmWorldSci. 2

8. Day D. Use of pharmacy claimsdatabasesto determineratesof medicationadherence.Adv Ther. 2003May-Jun;20(3):164-76.

9. tenKlooster P, Taal E, vande Laar M.Rasch analysis of the DutchHealthAssessment Questionnaire Disability Indexandthe Hea

Questionnaire II inpatientswithrheumatoidarthritis. Arthritis andRheum. 2008;59(12):172128.

10.Wolfe F, MichaudK, PincusT. Development andvalidationof the HealthAssessment Questionnaire II:a revisedversionof the h

assessment questionnaire.Arthritis andRheum. 2004;50(10):3296305.

11.FerrazM, QuaresmaM, AquinoL, et al. Reliability of painscales inthe assessment of literate andilliterate patientswithrheum

J Rheumatol. 1990;17(8):1022-24.

12.MinnockP, KirwanJ, BresnihanB. Fatigue is areliable,sensitive andunique outcomemeasure inrheumatoidarthritis. Rheuma

2009;48:1533-36.

n Mean MPR [range] Mean HAQ-II Score [range] Mean Pain Score [range] Mean Fatigue Score [range]

90 0.939 [0.687-1] 0.56 [0-2.2] 3.1 [0-10] 3.1 [0-10]

6-Month Outcomes

51

12-Month Outcomes

58

Despite the burden of added time for the patient and

elevated operational costs for the pharmacy, measures of

disease activity at 6 or 12 months were collected by the

pharmacy team for nearly half of the patients meeting the

eligibility criteria.

107 patients were excluded because either their records

did not contain recorded outcomes or they were not

recorded at the correct interval of 6 and 12 months.

Patients levels of medication adherence met our

expectations and are likely attributable to the steps built

into the DTM program.

Our findings for the correlation between medication

adherence and HAQ-II scores is consistent with our

expectation that a higher MPR would correlate with a

lower HAQ-II score, however a correlation between

adherence and pain and fatigue was not found.

Study Limitations

Single-center study

Small sample size

Limited availability of data

Samples were not identical at 6 and 12 months

An increase in MPR shows a slight correlation with a

decrease in HAQ-II score, more so at 6 months than a

A correlation for pain and fatigue with MPR was not

demonstrated.

Inconsistencies in data collection may warrant closer

monitoring by pharmacy administrative staff, in orde

achieve the full potential of this DTM program.

These results provide some insights on the relations

between RA drug therapy adherence and measures o

disease activity. This not only offers community

pharmacies opportunities to improve patient care, b

also provides valuable data for this pharmacys

assessment of its current DTM program.

Drug Therapy Management Program

Patients receiving biologic therapy from this specialty pharmacy are enrolled into an RA DTM program, which includes

disease-specific education, training, and monitoring aimed to optimize medication adherence.

The Modified Health Assessment Questionnaire (HAQ-II) and numerical rating scales (NRS) for pain and fatigue are

administered at baseline and every six months thereafter.

Measured Outcomes

The correlation between the MPR and the patient-reported measures of disease activity are determined.

Adherence

Defined as medication possessionratio (MPR) and based onpharmacy refill record

Calculated using StandardizedTherapy Adherence Research Tool(START,Pfizer)8

HAQ-II

10-item questionnaire with higherscores (ranging 0-3) indicatinggreater disability9

Reliable and validated in assessingthe physical function of patientswith RA10

NRS for Pain and Fatigue

11-point (0-10) numerical scaleswith higher scores indicatingworse symptoms

Each have demonstratedreliability in assessing pain and

fatigue in patients with RA