Adults with juvenile idiopathic arthritis (JIA) treated with disease-modifying antirheumatic drugs (DMARDs) are more satisfied with biological medicines than with synthetic therapies such as methotrexate, a study based on patient questionnaires suggests.
Nonetheless, less than half of these patients took these medications as recommended.
DMARDs are one class of medications currently used to treat JIA, and include both synthetic (chemical compound) medicines, such as methotrexate, and biological therapies.
Following prescribed treatment regimens as recommended (adherence) is a key requirement for clinical benefit. However, studies have found that just over half of rheumatoid arthritis patients comply with treatment regimens.
Such research in JIA has focused on children, but as 40-60% of patients continue to experience symptoms into adulthood, a better understanding of the adherence to DMARDs in adults with this disorder is needed.
A team in Norway contacted adults with JIA, who as children had participated in a three-year study. From a total of 196 eligible patients, 96 (mean age of 25.1) agreed to participate.
The researchers collected information about medication use, and patients were given a series of questionnaires, which included a patient reports of active joint swelling.
Satisfaction with treatment was measured using the Treatment Satisfaction Questionnaire for Medication (TSQM), which evaluates effectiveness, side effects, convenience, and overall satisfaction. In turn, medication adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8), where 8 is high adherence and below 6 is low adherence.
Physical and mental health-related quality of life (HRQOL) was determined with the Short-Form Health Survey version 2, physical disability with the Health Assessment Questionnaire Disability Index, pain with the Brief Pain Inventory Short Form, and symptoms of psychological distress with the Hopkins Symptom Checklist.
Nineteen years after their diagnoses, 52 patients (54%) used synthetic DMARDs and/or biological DMARDs. Biological DMARDs were used by 37 patients (39%), either alone or in combination with methotrexate or sulfasalazine. Twenty-eight patients used methotrexate exclusively or in combination with biological DMARDs and sulfasalazine, while two patients used sulfasalazine alone.
Those using biological DMARDs alone reported significantly higher satisfaction with the medication — related to effectiveness and overall satisfaction — compared to those taking methotrexate. Participants using combination therapy also reported significantly higher satisfaction using biological DMARDs over methotrexate, based on side effects and overall satisfaction.
Lower satisfaction with medications was linked to pain intensity, physical disability, psychological distress, and active joints. Higher satisfaction related to effectiveness was strongly associated with a higher physical HRQOL, while overall satisfaction was linked with better physical and mental HRQOL.
The study also found that 46% of the patients reported low adherence to DMARDs, while 29% reported medium adherence, and 25% had high adherence.
Adherence to treatment was independent of age, gender, disease duration and course, active joints, effectiveness, side effects, and overall satisfaction. Treatment convenience was the only factor significantly linked to medication adherence.
“In conclusion, JIA patients’ medication satisfaction was higher with bDMARDs [biological DMARDs] than MTX [methotrexate] 19 years after disease onset,” the researchers wrote.
“Knowledge and incorporation of patients’ experience with medication is important in order to promote patient centered care and achieve the best possible HRQOL,” they added.