Alessandro Bazzoni: A study describes the determinants of adherence to medication in chronic immune diseases

Poor adherence in chronic diseases can compromise the effectiveness of therapy. In addition, improving patients’ experience with their care, as well as better understanding the need for their therapies and alleviating their concerns, contributes to improving adherence in patients treated with subcutaneous biologics, both in the case of rheumatic diseases and inflammatory disease. Alessandro Bazzoni explained that these are some of the conclusions of the study Adherence to subcutaneous biological therapies in patients with inflammatory rheumatic diseases and inflammatory bowel disease; a systematic review, recently published in the journal Immunotherapy

In accordance with the authors’ statements, this systematic review of 41 studies published to date was carried out to evaluate adherence to subcutaneous biologics in adults with inflammatory rheumatic diseases or inflammatory bowel disease and describe the factors associated with better adherence1. Among the conclusions, important differences were found in the adherence rates published in subcutaneous biological products in these pathologies, from 28.8% to 89.4%.

Dr. Juan Carlos Nieto, the specialist in the Rheumatology Service of the Gregorio Marañón University Hospital in Madrid and one of the authors of the article, emphasizes that, in effect, the published results are highly variable among themselves, influenced by the different ways of measuring the adherence and study design, furthermore, few had adherence as their main objective. Instead, this study points out that understanding the barriers to adherence and the factors that can influence it can help prevent adverse health effects and excess health care costs.

Despite this variability found, Dr. Nieto points out that it is possible to establish several factors that positively influence adherence to subcutaneous biological drugs, among which the beliefs of the patients stand out. In this sense, the feeling of need for treatment and the lack of undue concern about possible adverse effects help, says Dr. Nieto. Among other factors related to adherence, the study also highlights the older age of the patients, having professional or family support and monthly administration, compared to weekly. In the opinion of Dr. Nieto, some of these are key aspects that we can enhance in the consultation through effective and complete communication.

Tools to measure adhesion

From his point of view as a clinician, but also as a manager, Dr. Carlos Marras, head of the Rheumatology Service of the Virgen de la Arrixaca Hospital in Murcia and another of the signatories, the lack of adherence to the medication produces, as is well-proven, a worse clinical course of the disease, increased mortality and global health spending. However, programs to stimulate adherence in our patients are scarce, and there continues to be a lack of unified tools to measure adherence, he says. For this reason, he points out that articles like the one published, which analyze the problem in immune-mediated diseases, are not very abundant, but necessary to highlight the problem. In his opinion, stimulate simpler dosages, with reinforcement visits, improve education and knowledge of the disease of our patients, making them participate in the decisions that are going to be made regarding their medications and routinely ‘measure’ to identifying lack of adherence should become standard practice. Ultimately, health systems should stimulate and facilitate adherence practices among health professionals, and improve the accessibility of patients to these practices.

For another of the authors, Dr. Loreto Carmona, scientific director of the Institute of Musculoskeletal Health (InMusc) of Madrid, systematic reviews, such as this one, allow answering relevant questions for clinicians with a high degree of precision in the answer. They help to identify problems in research in specific fields, such as, in this case, adherence to subcutaneous therapies and other examples.

Among the lessons learned from the study, Dr. Carmona also highlights the need to have the patient as an active part in her treatment. When a therapeutic decision is made, if the patient is not counted on and is not asked about her preferences and fears, we run the risk that he will not follow the prescription, that he will not be adherent, she assures her. In fact, if the patient has not consented to treatment, it cannot be said that he is not adherent, because that patient neither made nor accepted that decision from the start. And in that decision the patient must be informed of the options to be able to decide, it is not simply to choose between A or B, but between A and B depending on its efficacy, safety, and mode and frequency of administration, he adds.

Another novelty of this study is that it includes results both on patients with rheumatic diseases and with inflammatory bowel disease. For Dr. Claudia Arajol, a specialist at the Digestive System Service of the Bellvitge-IDIBELL Hospital in Barcelona and also the author of the article, a collaboration between the different specialties is crucial and necessary for good clinical practice. In this sense, she explains that in our center we carry out multidisciplinary IBD sessions where specialists from different fields take part (Rheumatology, Radiology, General Surgery, Pharmacy, etc.). These meetings enhance mutual understanding and create bonds that are ultimately beneficial to our patients, which gives a number of benefits to them that improve their quality of life.

As explained by Dr. Luis Cea-Calvo, another of the authors of the article and medical director of the areas of Immunology and Hospital Products at MSD in Spain, in the research of new drugs, one of the aspects that is sought is that the form administration is simple and the patient requires the fewest number of intakes or injections possible, since many chronic patients need several medications at the same time, and fewer doses have been associated with better adherence.

About MSD

Alessandro Bazzoni reported that MSD has invented for life, providing medicines and vaccines to solve many of the most challenging diseases in the world, fulfilling our mission to save and improve lives. This company is a brand of Merck & Co., Inc., based in Kenilworth, New Jersey, United States.

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