Discontinuation, persistence and adherence to subcutaneous biologics delivered via a homecare route to Scottish adults with rheumatic diseases

• Autor(a) principal: Samantha Alvarez-Madrazo
• Data de Publicação: 2019
• Outros Autores: Kimberley Kavanagh, Stefan Siebert, Yvonne Semple, Brian Godman, Alessandra Maciel Almeida, Francisco de Assis Acurcio, Marion Bennie
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UFMG
• Texto Completo: http://dx.doi.org/10.1136/bmjopen-2018-027059; http://hdl.handle.net/1843/61168
• topic: Inflammatory rheumatic musculoskeletal diseases; Medication adherence; Biological drugs; Medication persistence; Doenças reumáticas; Doenças musculoesqueléticas; Produtos biológicos; Adesão à medicação

Objectives: To understand patterns of subcutaneous (SC) biologics use over time in adults with inflammatory rheumatic musculoskeletal diseases receiving a homecare delivery service. Design: Retrospective cohort. Setting: Patients in secondary care receiving SC biologics in the largest Scottish Health Board. Participants: A new bespoke cohort was created from routine data gathered as part of a health board Homecare Service Database. Patients over 18 years who received a supply of SC biologic from January 2012 to May 2015 with a diagnosis for rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS) were included. Outcomes measured: A standardised framework was applied by measuring discontinuation rates, persistence using Kaplan-Meier analysis and Cox regression and adherence using medication refill adherence (MRA) and compliance rate (CR). Results: 751 patients were identified (AS: 105, PsA: 227, RA: 419) of whom 89.3% had more than one biologic delivery (median days’ follow-up: AS: 494; PsA: 544; RA: 529) and 83.2% did not switch biologic. For all conditions, approximately half were persistent on their index biologic (52% AS, 54% PsA, 48%RA). Of patients who discontinued treatment, the majority reinitiated with the same biologic (19% AS, 18% PsA and 21% RA). Overall adherence during the period of treatment was over 80% when calculated using MRA (median %MRA: AS: 84.0%, PsA: 85.0%, RA: 82.4%) or CR (median %CR: AS: 96.6%, PsA: 97%, RA: 96.6%). Conclusion: Use of linked routine data is a sustainable pathway to enable ongoing evaluation of biologics use. A more consistent approach to studying use (discontinuation, persistence and adherence metrics) should be adopted to enable comparability of studies.