Factors Predicting Biologic Discontinuation in Inflammatory Rheumatic Disease

Adherence to treatment regimens including biologics for the management of chronic inflammatory rheumatic disease (CIRD) has been of great clinical interest, as early control of the inflammatory cascade is crucial in minimizing long-term morbidity.  The specific factors contributing to nonadherence behavior in patients with rheumatic disease prescribed biologics was studied by Anne-Laure Betegnie, PharmD, and colleagues in a recent study published in The Journal of Rheumatology.

The researchers studied 581 patients with CIRD who were prescribed biologic medication; 60.4% had ankylosing spondylitis (AS), 33.7% had rheumatoid arthritis (RA), 5.2% had psoriatic arthritis, and 0.7% had another CIRD. The most commonly reported biologic medications used by patients were etanercept (37.4%), adalimumab (29.8%), and infliximab (19.6%). Self-administration of biologics occurred in 72.5% of patients with AS, 58.3% of patients with RA, and 76.7% of patients with another CIRD. Self-reported adverse effects from biologic administration that interrupted daily life were described in 85% of patients.

Of the patients studied, 74% suspended biologic treatment at least once, with 56.7% of patients switching to another biologic and 30.1% later restarting prescribed treatment. Prescribed biologic treatment was self-discontinued in 14.8% of patients for a variety of reasons.

In multivariate analysis, 5 factors were significantly related to self-discontinuation: low levels of pain, the trial of more than 1 biologic medication, self-administration of biologics, negative beliefs about the treatment, and a lack of medical and social support. 

Summary and Clinical Applicability

Self-discontinuation of biologic medication was associated with 5 predictive factors in patients with CIRD. These factors included pain, treatment history, self-administration of injections, negative beliefs about treatment, and a lack of perceived medical and social support.  Routine assessment for these specific factors in patients with CIRD being treated with biologic drugs should be considered to increase the probability of long-term medication adherence.

Reference

Betegnie AL, Gauchet A, Lehmann A, et al. Why do patients with chronic inflammatory rheumatic diseases discontinue their biologics? An assessment of patients’ adherence using a self-report questionnaire. J Rheumatol. 2016; Feb 15.doi:10.3899/jrheum.150414. [Epub ahead of print]