Psychological factors predict adherence to methotrexate in rheumatoid arthritis; findings from a systematic review of rates, predictors and associations with patient-reported and clinical outcomes
Psychological factors predict adherence to methotrexate in rheumatoid arthritis; findings from a systematic review of rates, predictors and associations with patient-reported and clinical outcomes
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DOI：
10.1136/rmdopen-2015-000171
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发表时间：
2016-01-01
期刊：
影响因子：
6.2
通讯作者：
Verstappen, Suzanne M. M.
中科院分区：
文献类型：
--
作者：
Hope, Holly F.;Bluett, James;Verstappen, Suzanne M. M.
甲氨蝶呤（MTX）治疗类风湿性关节炎（RA）的反应并不普遍，不依从性可能部分解释了这一点。本系统综述的目的是：(1)总结现有的MTX依从率，(2)确定MTX依从性的预测因素，(3)评估不依从性与患者预后之间的关系。作者对1980年1月至2015年2月在PubMed、PsycINFO、EMBASE和CINAHL数据库中发表的论文进行了系统检索。符合纳入条件的研究有：(1)MTX作为单一疗法或与其他疗法联合使用，(2)MTX用于类风湿关节炎或炎症性多发性关节炎人群，(3)依从性被定义和测量为患者在处方期间遵循MTX方案的程度，(4)它是一项原创研究。总共有10项研究符合纳入标准，8项研究被评价为高质量。依从率从59%到107%不等，并且暴露了依从性定义、研究方法和样本异质性的差异。确定了许多MTX依从性的潜在预测因素；最强烈的与相信甲氨蝶呤的必要性和有效性、没有低落情绪、轻度疾病和甲氨蝶呤单药治疗有关。此外，有3项研究测试了依从性与疾病活动性之间的关系，并将其作为一种结果衡量标准；所有3例患者均发现不依从性与治疗反应差有关。本系统综述显示了坚持MTX治疗的重要性，并总结了相关的可改变因素。
Treatment response to methotrexate (MTX) for rheumatoid arthritis (RA) is not universal and non-adherence may partially explain this. The aims of this systematic review were to: (1) summarise existing rates of adherence to MTX, (2) identify predictors of adherence to MTX, and (3) assess the association between non-adherence and patient outcomes. The authors conducted a systematic search of papers published from January 1980 to February 2015 in PubMed, PsycINFO, EMBASE and CINAHL databases. Studies were eligible for inclusion if: (1) MTX was used as monotherapy or in combination with other therapies, (2) MTX was used in an RA or inflammatory polyarthritis population, (3) adherence was defined and measured as the extent to which patients followed their MTX regimen during the period of prescription, and (4) it was an original piece of research. In total, 10 studies met the inclusion criteria and 8 were evaluated as high quality. Rates of adherence ranged from 59% to 107%, and exposed differences in definitions of adherence, study methodologies and sample heterogeneity. A number of potential predictors of MTX adherence were identified; the strongest being related to beliefs in the necessity and efficacy of MTX, absence of low mood, mild disease and MTX monotherapy. Furthermore, 3 studies tested the association of adherence with disease activity as an outcome measure; all 3 found non-adherence associated with poor treatment response. This systematic review shows the importance of adherence to MTX treatment and summarises the associated modifiable factors.