gms | German Medical Science

Introduction: This study investigated treatment expectations in patients with rheumatoid arthritis (RA) before starting therapy with methotrexate (MTX), and to identify variables associated with discontinuation of MTX.

Methods: Consecutive patients with RA who were about to start MTX were prospectively included after informed consent. Treatment expectations, medication-related beliefs and adverse events, treatment satisfaction and health–related quality of life were assessed using the generic rating scale for previous experiences, expectations and effects of treatment (G-EEE), the general assessment of side effects (GASE), the beliefs about medicines questionnaire (BMQ), the treatment satisfaction questionnaire for medication (TSQM) and the EuroQol-5 dimensions (EQ-5D) before treatment initiation (T0), and after 3 months (T1). Treatment adherence to MTX was checked at month 6 (T2). Associations treatment expectations and adherence to MTX were explored by regression analyses.

Results: A total of n=100 consecutive RA patients before starting MTX treatment were included (table 1 [Tab. 1]). A history of inadequate response to sulfasalazine was determined in n=6 (6%) and to hydroxychloroquine in n=1 patient, respectively. At T0, patients perceived the need for treatment with MTX as high, and they were only moderately concerned regarding potential adverse events of this therapy. Treatment expectations regarding the decrease of pain levels and development of adverse events did not differ much between T0 and T1, when disease activity had significantly decreased and physical function increased. MTX was withdrawn in 3 out of 59 patients (5.0%) and in 13 out of 64 patients (20.3%) assessed at T1 and T2, respectively, with a mean of 16.0 (5.9) weeks after treatment initiation. The most frequent reason for discontinuation of MTX was the occurrence of adverse events (n=12) followed by infections or malignancies (both n=2). There was no significant relationship between patients’ treatment expectations reported at T0 and their adherence to MTX at T2.

Conclusion: In this study, we found no evidence for the assumption that patients’ expectations before the start of MTX did substantially influence adherence to treatment.