MTX Adherence: Education Versus Persuasion

Nearly half of patients prescribed oral or intravenous methotrexate (MTX) aren't taking it exactly as prescribed, according to a new study by Genentech and RTI researchers.

The results, scheduled to be revealed today at the 2014 annual meeting of EULAR (the European League Against Rheumatism), suggest a need to devise strategies to help patients remember to take it, and to solicit and address concerns about safety.

The study used a Web-based questionnaire to poll 501 patients who had been taking oral or injected MTX for at least four weeks, after a diagnosis of rheumatoid arthritis at least three months previously. Almost half (42%) said they had not taken the drug exactly as prescribed.

About one-fourth of these 211 respondents said they either forgot or thought they didn't need it because they were feeling fine:

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Generally poor education is unlikely to be a factor: More than three-fourths of these respondents had at least some college education. Adherence issues were most common among patients taking MTX as part of a combination, as well as younger patients, men, and those who hadn't been taking the drug for very long.

It may be somewhat simpler to respond to this information than to previous results on the topic, which suggest that nonadherence is a matter of strong belief rather than misunderstanding or forgetfulness. Another study on the same question, published in 2010 by researchers from Denmark, found that MTX compliance is strongest among patients who have a strong conviction that they need it.

Another study reported at EULAR 2014, this time about DMARDs in general, echoes the importance of feeling that the drug is worth taking. Hanneke Zwikker and a team from the Netherlands queried 580 RA patients taking DMARDs using a specific questionnaire about beliefs and medication and also about their adherence.

Irrespective of other psychological factors, they found, patients were less likely to take DMARDs as prescribed if they didn't feel strongly that they needed the medications, or if concerns about the medications weighed strongly against the perceived need for them.