November 19, 2018
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Adherence, Persistence Low in Veterans With RA Who Escalate to Triple Therapy

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Treatment adherence and persistence rates remain relatively low among veterans with rheumatoid arthritis who escalate from methotrexate to triple therapy with sulfasalazine and hydroxychloroquine, according to recent data in Arthritis Care & Research.

The researches further concluded treatment discontinuation was most often due to adverse drug events, specifically related to sulfasalazine.

“While methotrexate alone is an accepted first-line therapy for the treatment of RA, many patients require additional treatment,” Daniel P. Erhardt, MD, MPH, of the George E. Wahlen Veterans Affairs Medical Center, and colleagues wrote. “With the proven efficacy of these combination therapies, an understanding of the real-world observations outside of clinical trials should be investigated to determine if similar experiences are seen in clinical practice as in clinical trials.”

 
Treatment adherence and persistence rates remain relatively low among veterans with RA who escalate from methotrexate to triple therapy with sulfasalazine and hydroxychloroquine, according to recent data.
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To compare persistence and adherence rates between methotrexate-TNF inhibitor combination therapy and triple therapy with methotrexate, sulfasalazine and hydroxychloroquine, Erhardt and colleagues conducted a retrospective cohort study of VA clinical and administrative data from 2006 to 2012. This included data from the Department of Veterans Affairs, the Veterans Health Administration, Corporate Data Ware house, Pharmacy Benefits Management and Decision Support Services.

The researchers reviewed information on 2,125 patients on dual therapy, and 171 who received triple therapy, during the 12-month period after initiating combination treatment. Erhardt and colleagues defined persistence as treatment with gaps of less than 90 days only. Treatment strategies were considered adherent if the proportion of days covered reached at least 80%. In addition, the researchers used chart information to determine patients’ reasons for discontinuing treatment.

According to the researchers, the dual therapy group demonstrated 43.2% persistence, while the patients receiving triple therapy demonstrated 17.6% persistence. In addition, the methotrexate-TNF inhibitor group achieved 25.3% adherence, compared with 10.5% among those treated with triple therapy. The triple therapy group was associated with significantly higher numbers of treatment discontinuation, largely due to adverse drug events linked to sulfasalazine.

“This observational cohort study demonstrated that in U.S. veterans with RA, persistence and adherence rates remained relatively low when escalating from [methotrexate] to combination [methotrexate-TNF inhibitor] and [triple therapy], findings that mirror a larger recent study published by our group involving a larger cohort of U.S. veterans,” Erhardt and colleagues wrote.

However, the researchers noted “this study also helped elucidate via chart abstraction the reasons why patients discontinue their combination medications for their RA. Findings from our study indicate that [adverse drug events] play a significant role in influencing drug discontinuation, and further efforts should focus on ways to mitigate [adverse drug events] when initiating or escalating drug regimens for RA.” – by Jason Laday

Disclosure: Erhardt reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.