Rheumatology International

, Volume 37, Issue 7, pp 1195–1202 | Cite as

Identification of patients at risk of non-adherence to oral antirheumatic drugs in rheumatoid arthritis using the Compliance Questionnaire in Rheumatology: an ARCO sub-study

  • Carlos MarrasEmail author
  • Indalecio Monteagudo
  • Georgina Salvador
  • Francisco J. de Toro
  • Alejandro Escudero
  • Juan J. Alegre-Sancho
  • Enrique Raya
  • Ana Ortiz
  • Loreto Carmona
  • Yvonne Mestre
  • Luis Cea-Calvo
  • Jaime Calvo-Alén
Observational Ressearch


The ARCO study (Study on Adherence of Rheumatoid Arthritis patients to SubCutaneous and Oral Drugs), a multicenter, non-interventional retrospective study, was primarily designed to assess the percentage of patients [aged ≥18 years with an established rheumatoid arthritis (RA) diagnosis] with non-adherence to prescribed subcutaneous biologicals. This paper reports data for the secondary objective from a subset of patients, namely to evaluate non-adherence to prescribed oral antirheumatic drugs in RA patients in Spain using the validated Compliance Questionnaire Rheumatology (CQR). Patients also completed the Morisky–Green Medication Adherence Questionnaire, Beliefs about Medicines Questionnaire, and a questionnaire (developed and validated in Spain) on patient satisfaction with RA treatment and preferences. A total of 271 patients (76.7% females; mean age 55.6 years) were being treated with oral drugs for RA, of which 234 completed the CQR questionnaire. Non-adherence was reported in 49/234 (20.9%) patients. The proportion of non-adherence in younger patients (aged ≤48 years; 37.5%) was double that recorded in patients aged >48 years (p = 0.006). Patients with a perception of lower efficacy also had a higher risk of non-adherence (p = 0.012). Multivariable analysis showed that younger age and male gender were independently associated with risk of non-adherence. There was only slight agreement between the CQR and Morisky–Green assessment tools (kappa coefficient = 0.186), possibly reflecting the fact that both questionnaires measure slightly different aspects of medication adherence. In conclusion, one out of five RA patients was identified as at risk for non-adherence with the CQR, and this was more frequent in younger patients and in males.


Adherence Non-adherence Oral medication Questionnaire Rheumatoid arthritis 



Study implementation and statistical analysis were conducted by Experior S.L, Spain. Medical writing assistance was provided by David P. Figgitt Ph.D., Content Ed Net, with funding from Merck Sharp & Dohme, Spain. The authors would like to thank the 42 study investigators for their contribution to patient recruitment and data acquisition, and to the patients involved for their collaboration in completing the study questionnaires.

Compliance with ethical standards

Conflict of interest

The ARCO study was financed by Merck Sharp & Dohme, Spain, a subsidiary of Merck & Co, Kenilworth, New Jersey, USA. Yvonne Mestre and Luis Cea-Calvo are full-time employees of Merck Sharp & Dohme (MSD), Spain. The co-authors of the manuscript were also study investigators, and they or their institution received financial compensation for the enrolment of patients in the study. Georgina Salvador has received payments for lectures from BMS, Roche, AbbVie, Amgen, and Pfizer, and for the development of educational presentations from BMS, Roche, Pfizer, AbbVie, and MSD. Juan J. Alegre has received payments as a board member from AbbVie; for consultancy from MSD; for his expert testimony from Roche; for lectures from AbbVie, MSD, Roche, BMS, and Pfizer; for the development of educational presentations from BMS; and his institution has received grants from AbbVie. Ana Ortiz has received payments for grants from the “Instituto de Salud Carlos III”. L. Carmona’s institution (InMusc.) has received consultancy honoraria from MSD. The rest of the authors declare no other conflicts of interest.

Supplementary material

296_2017_3737_MOESM1_ESM.doc (140 kb)
Supplementary material 1 (DOC 139 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Carlos Marras
    • 1
    Email author
  • Indalecio Monteagudo
    • 2
  • Georgina Salvador
    • 3
  • Francisco J. de Toro
    • 4
  • Alejandro Escudero
    • 5
  • Juan J. Alegre-Sancho
    • 6
  • Enrique Raya
    • 7
  • Ana Ortiz
    • 8
  • Loreto Carmona
    • 9
  • Yvonne Mestre
    • 10
  • Luis Cea-Calvo
    • 10
  • Jaime Calvo-Alén
    • 11
  1. 1.Hospital Universitario Virgen de ArrixacaMurciaSpain
  2. 2.Hospital Universitario Gregorio MarañónMadridSpain
  3. 3.Hospital Universitario Mutua de TerrassaBarcelonaSpain
  4. 4.Hospital Universitario A CoruñaA CoruñaSpain
  5. 5.Hospital Universitario Reina SofíaCórdobaSpain
  6. 6.Hospital Universitario Dr PesetValenciaSpain
  7. 7.Hospital Universitario San CecilioGranadaSpain
  8. 8.Hospital Universitario La Princesa, IIS La PrincesaMadridSpain
  9. 9.Instituto de Salud MusculoesqueléticaMadridSpain
  10. 10.Medical AffairsMerck Sharp & DohmeMadridSpain
  11. 11.Hospital Txagorritxu, ArabaVitoriaSpain

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