Medication adherence in older people with rheumatoid arthritis is lower according to electronic monitoring than according to pill count

Linda Hartman, Maurizio Cutolo, Reinhard Bos, Daniela Opris-Belinski, Marc R Kok, Hanneke J R M Griep-Wentink, Ruth Klaasen, Cornelia F Allaart, George A W Bruyn, Hennie G Raterman, Marieke J H Voshaar, Nuno Gomes, Rui M A Pinto, L Thomas Klausch, Willem F Lems, M Boers, Linda Hartman, Maurizio Cutolo, Reinhard Bos, Daniela Opris-Belinski, Marc R Kok, Hanneke J R M Griep-Wentink, Ruth Klaasen, Cornelia F Allaart, George A W Bruyn, Hennie G Raterman, Marieke J H Voshaar, Nuno Gomes, Rui M A Pinto, L Thomas Klausch, Willem F Lems, M Boers

Abstract

Objectives: Suboptimal medication adherence is a serious problem in the treatment of chronic inflammatory diseases. To measure medication adherence, electronic monitoring is regarded as superior to pill count. GLORIA is an ongoing two-year trial on the addition of low-dose (5 mg/d) prednisolone or placebo to standard care in older people (65+ years) with RA. During the entire trial, adherence is measured with electronic caps, and with pill counts. The objective is to describe medication adherence patterns, and to compare the adherence results of the two methods.

Methods: The recorded adherence patterns of patients (blinded for treatment group) were classified according to descriptive categories. The cutoff for good adherence was set at 80% of prescribed pills taken.

Results: Trial inclusion closed in 2018 at 451 patients, but trial follow-up is ongoing; the current dataset contains adherence data of 371 patients. Mean number of recorded 90-day periods per patient was 4 (range 1-8). Based on pill count over all periods, 90% of the patients had good adherence; based on cap data, only 20%. Cap data classified 30% of patients as non-user (<20% of days an opening) and 40% as irregular user (different adherence patterns, in or between periods).

Conclusion: In our trial of older people with RA, the majority appeared to be adherent to medication according to pill count. Results from caps conflicted with those of pill counts, with patterns suggesting patients did not use the bottle for daily dispensing, despite specific advice to do so.

Trial registration: NCT02585258. ClinicalTrials.gov (https://www.clinicaltrials.gov/).

Keywords: electronic monitoring; glucocorticoids; medication adherence; pill count; rheumatoid arthritis.

© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.

Figures

Fig . 1
Fig. 1
Medication bottle used in the GLORIA trial
Fig . 2
Fig. 2
Flow chart of patients included in the adherence analyses
Fig . 3
Fig. 3
Medication adherence measured with pill count and electronic caps (A) Medication adherence measured with pill count (blue) and electronic caps (red) per single period and over all periods. Individual results left, boxplots (whiskers indicate p10 and p90) on the right. (B) Scatterplot of medication adherence (%) per single period according to pill count vs electronic caps.
Fig . 4
Fig. 4
Examples of medication adherence patterns Yellow: no opening; green: 1 opening; blue: ≥2 openings on that day.
Fig . 5
Fig. 5
Patients categorized by their predominant pattern of electronic cap use

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