October 17, 2018
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Text Message Reminders Improve Methotrexate Adherence in RA

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Weekly text message reminders have a positive impact on methotrexate adherence among adult patients with rheumatoid arthritis, according to findings in Arthritis Care & Research.

“The strong association between poor adherence in RA and worsening clinical scores suggests that early interventions to improve adherence to [methotrexate] may slow joint erosion and reduce the subsequent need for more expensive immunosuppressive drugs,” Aurélien Mary, PharmD, PhD, of Amiens Picardie University Hospital, France, and colleagues wrote. “The use of iterative text message reminders about taking drugs ... is a recently initiated method for improving the management of chronic disease. It has given positive results in the treatment of HIV, hypertension and hypercholesterolemia.”

To determine the effect of text messages as reminders on adherence rates among patients with RA taking methotrexate, the researchers conducted a 6-month, prospective, randomized pilot, singlesite pilot study of adults treated at the Amiens Picardie University Hospital rheumatology department. A total of 112 patients with RA who had been stabilized on methotrexate, with or without biologics, were randomly assigned to one of three interventions: 37 received weekly text message reminders regarding their treatment, 37 had a 15-minute counseling session with a pharmacist, and 38 participants in the control group received standard consultation.

Mary and colleagues measured the change over time in Compliance Questionnaire Rheumatology (CQR19) scores between baseline and 6 months. In addition, the researchers evaluated multivariate analyses and final adherence — defined as a composite outcome of the CQR19 score, the Girerd score and the medication possession ratio — in sensitivity tests. They also analyzed inflammation and patient satisfaction. Among the 112 participants, 16 were excluded due to an inability to measure their adherence at the end of the study, resulting in 96 patients being included in the final analysis.

According to the researchers, change over time in CQR19 score was significantly higher among participants in the text message group (3.32 ± 5.66; P = .02) than those in both the control (0.22 ± 6.56) and counselling (–0.14 ± 7.56) groups. In addition, multivariable logistic regression demonstrated that text message reminders were associated with an increase in the CQR19 score independent of the baseline CQR19 score (OR = 3.63; 95% CI, 1.2610.49). Among patients in the texting group, increased CQR19 scores were correlated with Health Assessment Questionnaire scores (r = –0.405; P = .021). In addition, patient satisfaction was significantly higher in the texting group compared with the control (P < .01).

“The receipt of [text message] reminders slightly but significantly increase treatment adherence in patients with RA taking [methotrexate],” Mary and colleagues wrote. “The relatively low cost of this intervention (which, for example, is included in the free application recently developed by the French Rheumatology Society) might justify its use in the care of patients receiving long-term treatment with [methotrexate].” – by Jason Laday

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