Motivations Behind Rx Non-Compliance in RA

Rheumatoid arthritis patients revealed why they did not take their medications

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) According to Pharmaceutical Research and Manufacturers of America (PhRMA), about 75 percent of adults don’t take their medications as prescribed. A new study looked at this issue in rheumatoid arthritis patients.

Two out of three newly diagnosed rheumatoid arthritis patients in this study were what the researchers called non-persistent. That is, these patients didn’t consistently take their medicines as directed.

Patients in the study said they didn’t take their medicines as prescribed because it was hard to find the medicines and because the medications were expensive.

"Take all your medications as directed by your doctor."

Virginia Pascual-Ramos and Irazú Contreras-Yáñe, of the Department of Immunology and Rheumatology at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Tlalpan, México, conducted this study to identify motivations and risk factors for non-persistence in early rheumatoid arthritis (RA) patients.

“Inadequate medication adherence (which includes three major components: persistence, initiation adherence and execution adherence) causes an increased financial burden for society as it has been associated to excess emergency care visits and hospitalizations, higher treatment costs and loss of productivity,” these researchers wrote.

“One logical target in trying to complete the riddle of therapeutic non-compliance in RA would be to identify most common associated factors from the patient’s perspective and to identify predictors as we did in the present study.”

These researchers defined non-persistence as patients who indicated that they always, almost always or sometimes completely stopped taking their RA medications, known as disease modifying anti-rheumatic drugs (DMARDs).

Examples of DMARDs include methotrexate (brand names Rheumatrex, Trexall), sulfasalazine (brand name Azulfidine) and hydroxychloroquine (brand name Plaquenil).

Participants in this study included 149 newly diagnosed RA patients from the early arthritis clinic at the Instituto Nacional de Ciencias Médicas y Nutrition Salvador Zubiran in Tlalpan, México.

Most of these participants had government insurance, but that coverage did not cover medication costs. Also, the researchers explained that the DMARDs were not available at the local pharmacy.

The researchers used a 22-item questionnaire to evaluate participants' medication compliance.

Among the group, 99 patients were classified as non-persistent, and 50 were classified as persistent. Non-persistent patients tended to have more formal education, more disease activity and higher disability than their counterparts.

The perception that the arthritis medications were difficult to find and that they were expensive were the primary reasons for non-persistence.

Other reasons for not taking their medications as directed included forgetfulness and lack of financial resources to pay for the medicines.

“Health systems should provide (first line) treatment for RA as a strategy to improve compliance with therapy and clinical outcomes, particularly in vulnerable populations,” the authors of this study concluded.

Steve Leuck, PharmD, founder of AudibleRx, told dailyRx News, "We are facing a serious medication-education-gap that is growing on a daily basis between patients and their health care providers. First, health care providers need to take the time to assure patients understand their diagnosis as well as the consequences of not treating their diagnosis. Second, patients need to become motivated to participate in their own health care.

"Many states and counties have programs available to help individuals receive their medication therapy; however, the patient needs to take the initiative and seek out the available options," said Dr. Leuck.

This study was published December 1 in BMC Musculoskeletal Disorders.

No conflicts of interest were reported.

Review Date: 
December 5, 2013
Last Updated:
January 2, 2014