Adherence to treatment in rheumatoid arthritis (RA) remains a significant challenge, with rates ranging from 30% to 80%, according to the findings of the STRATEGE2 study at the American College of Rheumatology Convergence.

This issue is particularly critical for methotrexate (MTX) and targeted therapies, the investigators noted in their poster presentation, as nonadherence negatively impacts disease outcomes. Building on the 2019 guidelines emphasizing the multifactorial nature of nonadherence, the STRATEGE2 study investigated real-life treatment adherence in patients with RA receiving MTX at the initiation of their first biologic or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) over a 2-year follow-up period.

The study enrolled 180 patients with RA from February 2019 to December 2020 who had been on MTX for at least 3 months and were starting their first b/tsDMARD due to active disease. Adherence was assessed using the Compliance Questionnaire for Rheumatology (CQR19), with a score ≤80 indicating nonadherence (NAd). CQR19 data were collected at baseline, 12 months (12M), and 24 months (24M). Patients were categorized into 2 groups: those nonadherent at all 3 steps (N-Ad group) and those who were adherent at least once (Ad group). Shared decision-making (SDM) involvement was evaluated using a 5-point Likert scale for both patients and physicians.

Of 180 patients, 100 had complete CQR19 data over the study period, with 32 categorized as NAd and 68 as Ad. Baseline characteristics showed no significant differences between the groups, except for the route of MTX administration. Most participants were female (75.0%), with a mean age of 57.2 years and a disease duration of 6.1 years. MTX use was comparable between groups, with an average dose of 18.9 mg/week. At baseline, 62.5% of NAd patients used subcutaneous (SC) MTX compared to 86.8% of Ad patients, a difference that persisted over 24 months (12M: 38.5% vs. 68.3%; 24M: 38.5% vs. 64.2%; p < 0.05).

Throughout the study, both groups experienced reductions in disease activity, though differences were not statistically significant. Therapeutic strategies were similar, with 55.0% of patients in both groups requiring at least 1 treatment adaptation and 16.0% discontinuing their b/tsDMARD. The mean MTX dose decreased to 14.9 mg/week, and 21.0% of patients discontinued MTX entirely. However, the lower use of the MTX SC route in the NAd group emerged as a defining characteristic.

SDM was another critical differentiator. NAd patients reported feeling less involved in decision-making regarding their treatment, although this perception was not shared by their physicians.

The STRATEGE2 study highlights 2 key characteristics of patients with persistent nonadherence: reduced use of SC MTX and lower involvement in SDM. These findings underscore the importance of addressing both medication administration methods and patient engagement to improve adherence. Enhancing SDM practices and considering patient preferences for MTX administration may be pivotal in improving treatment outcomes for patients with RA.

Reference

Gaujoux-VialaC. What happens in rheumatoid arthritis treatment adherence, two years after the introduction of targeted therapy? Results from the stratege2 study. Presented at: American College of Rheumatology. November 14-19, 2024; Washington, DC.