A scoping review of disease-modifying antirheumatic drug nonadherence in rheumatoid arthritis: Measurement, prevalence and implications for clinical practice
Date
2025
Authors
Fraser, L.
Ailabouni, N.
Ellett, L.K.
Tan, J.M.
Freeman, A.
Proudman, S.M.
Reeve, E.
Wiese, M.D.
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Journal article
Citation
British Journal of Clinical Pharmacology, 2025; 91(12):1-11
Statement of Responsibility
Lauren Fraser, Nagham Ailabouni, Lisa Kalisch Ellett, Jiun Ming Tan, Anthea Freeman, Susanna M. Proudman, Emily Reeve, Michael D. Wiese
Conference Name
Abstract
Aims Adherence to disease-modifying antirheumatic drugs (DMARDs) has been associated with improved treatment outcomes, but how adherence is reported ranges between studies. We therefore aimed to determine how nonadherence to DMARDs used to treat rheumatoid arthritis (RA) has been measured and to report the nonadherence rate with each measure identified. Additionally, we aimed to explore what factors are associated with nonadherence. Methods A scoping review was conducted in the following databases: Embase, Medline, Scopus and Cochrane, searching from 2000 up to 31 August 2022 using search terms related to ‘adherence’; ‘measures’; rheumatoid arthritis'; and ‘medication’. Descriptive analyses were used to analyse and interpret the data according to the stated aims. We included 172 manuscripts that met the inclusion criteria and the median number of participants for each study was 249 (interquartile range 120–767). Measures of adherence included dispensing data, tablet counts, self-report and physician estimates, electronic monitors, questionnaires and blood assays. Results Nonadherence was most commonly reported as a proportion and ranged from 1.5 to 100% for any DMARDs as a class, 0 to 95% for conventional synthetic DMARDs and 3 to 95% for biologic DMARDs. Increased disease activity, younger age and comorbidities were found in several studies to be associated with nonadherence, while there were inconsistent findings for sex, education, disease duration and other patient characteristics. Conclusion Much variability exists in the reported prevalence of nonadherence in RA, in what measures are used to assess nonadherence, how nonadherence is reported and which patient characteristics are associated with nonadherence.
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© 2025 The Author(s). British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.