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Predictors of patient decision to discontinue anti-rheumatic medication in patients with rheumatoid arthritis: results from the Ontario best practices research initiative

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Abstract

Despite the availability of treatment guidelines and effective treatments, real-world effectiveness remains suboptimal partly due to poor patient medication adherence. We evaluated a comprehensive set of sociodemographic, health insurance, and disease-related factors for association with patient decision to discontinue anti-rheumatic medications (ARMs) in a large observational RA cohort in Ontario, Canada. Patients from the Ontario Best Practices Research Initiative registry were included. The following predictors of ARM discontinuation were evaluated with cox-regression: patient age, gender, education, income, smoking, health insurance type/coverage, RA duration, erosion presence, RF positivity, DAS28-ESR, physician global, HAQ-DI, comorbidity number, ARM types, and physician characteristics (gender, academic position, urban vs. rural, distance from patient’s residence). Patients (1762) were included with a mean (SD) age of 57.4 years (13.0). Approximately 80% were female, 29% had early (≤ 1 year) RA, and 70% were RF-positive. Mean (SD) baseline DAS28-ESR and HAQ-DI were 4.5 (1.5) and 1.2 (0.76), respectively. In multivariate analysis, married status (HR [95%CI] 0.73 [0.56–0.96]), RF positivity (0.73 [0.56–0.96]), and higher comorbidity number (0.92 [0.85–0.99]) were significant predictors of ARMs continuation while higher physician global (1.10 [1.04–1.15]), NSAID use (1.75 [1.29–2.38]), and number of ARMs (1.23 [1.07–1.40]) were associated with ARMs discontinuation. In a subset analysis assessing conventional or biologic DMARD discontinuation, higher HAQ-DI and biologic use over time were associated with lower hazard for discontinuation. Several sociodemographic, disease, and treatment parameters were identified as independent predictors of patient discontinuation of ARMs. These results should be considered when developing patient adherence support programs and in the choice of treatment regimens.

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Acknowledgements

The authors would like to thank the following investigators participating in OBRI:

Ahluwalia, V., Ahmad, Z., Akhavan, P., Albert, L., Alderdice, C., Aubrey, M., Bajaj, S., Bensen, B., Bhavsar, S., Bombardier, C., Bookman, A., Carette, S., Carmona, R., Chow, A., Ciaschini, P., Cividino, A., Cohen, D., Dixit, S., Haaland, D., Hanna, B., Haroon, N., Hochman, J., Jaroszynska, A., Johnson, S., Joshi, R., Kagal, A., Karasik, A., Karsh, J., Keystone, E., Khalidi, N., Kuriya, B., Larche, M., Lau, A., LeRiche, N., Leung, Fe., Leung, Fr., Mahendira, D., Matsos, M., McDonald-Blumer, H., Mittoo, S., Mody, A., Montgomery, A., Mulgund, M., Ng, E., Papneja, T., Pavlova, P., Perlin, L., Pope, J, Purvis, J., Rohekar, G., Rohekar, S., Samadi, N., Shaikh, S., Shickh, A., Shupak, R., Smith, D., Soucy, E., Stein, J., Thompson, A., Thorne, C., Wilkinson, S.

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Author notes

  1. Emmanouil Rampakakis and Mohammad Movahedi contributed equally.

Authors and Affiliations

  1. William Osler Health System, 314-40 Finchgate Blvd, Brampton, ON, L6T 3J1, Canada

    Vandana Ahluwalia

  2. JSS Medical Research, St-Laurent, QC, Canada

    Emmanouil Rampakakis, Mohammad Movahedi & John S. Sampalis

  3. Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada

    Mohammad Movahedi, Angela Cesta, Xiuying Li & Claire Bombardier

  4. McGill University, Montreal, QC, Canada

    John S. Sampalis

  5. Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada

    Claire Bombardier

  6. Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada

    Claire Bombardier

Authors
  1. Vandana Ahluwalia
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  2. Emmanouil Rampakakis
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  3. Mohammad Movahedi
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  4. Angela Cesta
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  5. Xiuying Li
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  6. John S. Sampalis
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  7. Claire Bombardier
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Corresponding author

Correspondence to Vandana Ahluwalia.

Ethics declarations

OBRI was funded by peer-reviewed grants from CIHR (Canadian Institute for Health Research), Ontario Ministry of Health and Long-Term Care (MOHLTC), Canadian Arthritis Network (CAN), and unrestricted grants from AbbVie, Amgen, Bristol Myers Squibb, Celgene, Hospira, Janssen, Pfizer, Roche, Sanofi, and UCB.

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Ahluwalia, V., Rampakakis, E., Movahedi, M. et al. Predictors of patient decision to discontinue anti-rheumatic medication in patients with rheumatoid arthritis: results from the Ontario best practices research initiative. Clin Rheumatol 36, 2421–2430 (2017). https://doi.org/10.1007/s10067-017-3805-4

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  • DOI: https://doi.org/10.1007/s10067-017-3805-4

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