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Tuesday, September 18, 2018
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Text Message: Take Your Methotrexate! (CME/CE)

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Text Message: Take Your Methotrexate!

Pilot program found better adherence in rheumatoid arthritis patients with weekly reminders

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  • by Senior Staff Writer, MedPage Today

Action Points

  • A small pilot program in which patients with rheumatoid arthritis (RA) were sent weekly text messages reminding them to take their methotrexate was associated with improved medication adherence, according to French researchers.
  • Note that a recent meta-analysis found that nonadherence was associated with an increase in the Disease Activity Score and an increase in the number of joints that were painful.

A pilot program in which patients with rheumatoid arthritis (RA) were sent weekly text messages reminding them to take their methotrexate was associated with improved medication adherence, French researchers found.

In a prospective trial in which patients were randomized to receive text messages on their mobile phones, a 15-minute counseling session with a pharmacist, or standard care alone (controls), a significant difference at 6 months was seen on the Compliance Questionnaire Rheumatology (CQR-19) between the text-message group (3.32) versus the control group (-0.14, P=0.019), according to Aurélien Mary, PhD, PharmD, and colleagues from Amiens Picardie University Hospital in Amiens.

In contrast, no difference over time was seen in the CQR-19 scores between the control group and the pharmacist-counseling group (-0.22), the researchers reported online in Arthritis Care & Research.

Several reasons have been suggested for the frequent nonadherence to methotrexate treatment among patients with RA, including the drug’s gastrointestinal adverse events, unintentional forgetfulness about a once-weekly drug, and a lack of perceived need for treatment during symptom-free periods.

But a meta-analysis recently found that nonadherence was associated with an increase of 0.48 points on the Disease Activity Score in 28 joints (DAS28) and an increase of 1.29 in the number of joints that were painful. Moreover, “poor adherence has a health economic impact on society via a combination of direct costs (related to waste) and indirect costs (related to poor disease control),” the researchers wrote.

The use of iterative text messages has been shown to improve the management of several chronic diseases, including HIV infection and hypertension. To see if this could also be beneficial in RA management, the researchers conducted an open prospective study of adults with stable disease followed in their rheumatology department. Participants could be on methotrexate alone or in combination with other medications including biologics.

Study Details

The primary outcome measure was the change in CQR-19 over 6 months, with secondary measures including the Girerd score (a French risk calculator for drug adherence used in general practice), and the medication possession ratio, which reflects the number of prescription renewals and the drug units remaining in the patient’s possession at each study visit.

The investigators also calculated a composite measure with CQR-19 scores higher than 80, Girerd scores of 1 or less, and medication possession ratio above 80.

The study included 96 patients, with the majority being women. Mean age was 58, and mean time since diagnosis was 12 years. Mean duration of methotrexate treatment was 10 years, mean dose level was 15 mg, and more than half of patients were also on biologics.

At baseline, the mean CQR-19 score was 81.9 and mean Girerd score was 0.75. Adherence to methotrexate was considered good in 59% of patients.

On the composite outcome, the proportion of patients considered adherent was 78% in the text-message group, 53% in the pharmacist-counseled group, and 56% in the control group.

To determine whether baseline adherence influenced the change in adherence over time, the researchers conducted a sensitivity analysis that showed an independent association between receipt of text messages and change in CQR-19 scores (OR 3.63, 95% CI 1.26-10.49, P=0.017). The association was also independent of the methotrexate dose.

There was no evidence of effects on disease progression in any group in the study as reflected in DAS28 scores and laboratory measures such as erythrocyte sedimentation rate and C-reactive protein, probably because of the short duration and small sample size, according to the authors.

At 6 months, the DAS28 was below 2.6, indicating remission, in 62.5% of the text-message group, 57% of the pharmacist-counseled group, and 56% of the control group.

However, the change over time in the CQR-19 score did correlate with a decrease on the Health Assessment Questionnaire, which measures disability (r = -0.405, P=0.021). This suggested that the program had “a modest clinical impact,” the researchers observed.

Approximately 75% of patients were satisfied or very satisfied with their treatment program, with those ratings more common among the two intervention groups.

Previous studies found that a pharmacist-led intervention improved adherence in other diseases such as diabetes and hypercholesterolemia. In this study, however, pharmacist counseling was not associated with an improvement in the CQR-19, even with the use of additional written informative material.

“Taken together, these data show that patient education has limitations, even when it improves the level of knowledge about the disease and its treatment,” the researchers wrote.

The low cost of the program could justify its implementation among RA patients on methotrexate, but “the results of this pilot study need to be confirmed by further studies in new users of methotrexate and in highest-risk patients (with both poor adherence and high activity of RA).”

A limitation of the study, the team said, was the small sample size.

The authors reported having no financial conflicts.

2018-09-14T14:30:00-0400
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Medpage Today

Text Message: Take Your Methotrexate!

Pilot program found better adherence in rheumatoid arthritis patients with weekly reminders

MedpageToday

  • register today

    Earn Free CME Credits by reading the latest medical news in your specialty.

    sign up

  • by Senior Staff Writer, MedPage Today

Action Points

  • A small pilot program in which patients with rheumatoid arthritis (RA) were sent weekly text messages reminding them to take their methotrexate was associated with improved medication adherence, according to French researchers.
  • Note that a recent meta-analysis found that nonadherence was associated with an increase in the Disease Activity Score and an increase in the number of joints that were painful.

A pilot program in which patients with rheumatoid arthritis (RA) were sent weekly text messages reminding them to take their methotrexate was associated with improved medication adherence, French researchers found.

In a prospective trial in which patients were randomized to receive text messages on their mobile phones, a 15-minute counseling session with a pharmacist, or standard care alone (controls), a significant difference at 6 months was seen on the Compliance Questionnaire Rheumatology (CQR-19) between the text-message group (3.32) versus the control group (-0.14, P=0.019), according to Aurélien Mary, PhD, PharmD, and colleagues from Amiens Picardie University Hospital in Amiens.

In contrast, no difference over time was seen in the CQR-19 scores between the control group and the pharmacist-counseling group (-0.22), the researchers reported online in Arthritis Care & Research.

Several reasons have been suggested for the frequent nonadherence to methotrexate treatment among patients with RA, including the drug's gastrointestinal adverse events, unintentional forgetfulness about a once-weekly drug, and a lack of perceived need for treatment during symptom-free periods.

But a meta-analysis recently found that nonadherence was associated with an increase of 0.48 points on the Disease Activity Score in 28 joints (DAS28) and an increase of 1.29 in the number of joints that were painful. Moreover, "poor adherence has a health economic impact on society via a combination of direct costs (related to waste) and indirect costs (related to poor disease control)," the researchers wrote.

The use of iterative text messages has been shown to improve the management of several chronic diseases, including HIV infection and hypertension. To see if this could also be beneficial in RA management, the researchers conducted an open prospective study of adults with stable disease followed in their rheumatology department. Participants could be on methotrexate alone or in combination with other medications including biologics.

Study Details

The primary outcome measure was the change in CQR-19 over 6 months, with secondary measures including the Girerd score (a French risk calculator for drug adherence used in general practice), and the medication possession ratio, which reflects the number of prescription renewals and the drug units remaining in the patient's possession at each study visit.

The investigators also calculated a composite measure with CQR-19 scores higher than 80, Girerd scores of 1 or less, and medication possession ratio above 80.

The study included 96 patients, with the majority being women. Mean age was 58, and mean time since diagnosis was 12 years. Mean duration of methotrexate treatment was 10 years, mean dose level was 15 mg, and more than half of patients were also on biologics.

At baseline, the mean CQR-19 score was 81.9 and mean Girerd score was 0.75. Adherence to methotrexate was considered good in 59% of patients.

On the composite outcome, the proportion of patients considered adherent was 78% in the text-message group, 53% in the pharmacist-counseled group, and 56% in the control group.

To determine whether baseline adherence influenced the change in adherence over time, the researchers conducted a sensitivity analysis that showed an independent association between receipt of text messages and change in CQR-19 scores (OR 3.63, 95% CI 1.26-10.49, P=0.017). The association was also independent of the methotrexate dose.

There was no evidence of effects on disease progression in any group in the study as reflected in DAS28 scores and laboratory measures such as erythrocyte sedimentation rate and C-reactive protein, probably because of the short duration and small sample size, according to the authors.

At 6 months, the DAS28 was below 2.6, indicating remission, in 62.5% of the text-message group, 57% of the pharmacist-counseled group, and 56% of the control group.

However, the change over time in the CQR-19 score did correlate with a decrease on the Health Assessment Questionnaire, which measures disability (r = -0.405, P=0.021). This suggested that the program had "a modest clinical impact," the researchers observed.

Approximately 75% of patients were satisfied or very satisfied with their treatment program, with those ratings more common among the two intervention groups.

Previous studies found that a pharmacist-led intervention improved adherence in other diseases such as diabetes and hypercholesterolemia. In this study, however, pharmacist counseling was not associated with an improvement in the CQR-19, even with the use of additional written informative material.

"Taken together, these data show that patient education has limitations, even when it improves the level of knowledge about the disease and its treatment," the researchers wrote.

The low cost of the program could justify its implementation among RA patients on methotrexate, but "the results of this pilot study need to be confirmed by further studies in new users of methotrexate and in highest-risk patients (with both poor adherence and high activity of RA)."

A limitation of the study, the team said, was the small sample size.

The authors reported having no financial conflicts.

2018-09-14T14:30:00-0400
Take Posttest Comments

Accessibility Statement

At MedPage Today, we are committed to ensuring that individuals with disabilities can access all of the content offered by MedPage Today through our website and other properties. If you are having trouble accessing www.medpagetoday.com, MedPageToday's mobile apps, please email legal@ziffdavis.com for assistance. Please put "ADA Inquiry" in the subject line of your email.



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Dr Irfanullah Khan Born: 15th July,1994 in Khagram,Dir Upper KPK Pakistan. Others names:Doctor Irfo,Peshoo Education:Pharm-D Scholar Graduated from Abasyn University Peshawar. Occupation:Clinical Pharmacist,Doctor,Entrepreneur. Home Town:Dir Upper Height: 6 feet. Website:Iukmedonline.com

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