Rheumatology International

, Volume 37, Issue 10, pp 1709–1718 | Cite as

Adherence of rheumatoid arthritis patients to biologic disease-modifying antirheumatic drugs: a cross-sectional study

  • Natalia Mena-Vazquez
  • Sara Manrique-Arija
  • Lucía Yunquera-Romero
  • Inmaculada Ureña-Garnica
  • Marta Rojas-Gimenez
  • Carla Domic
  • Francisco Gabriel Jimenez-Nuñez
  • Antonio Fernandez-Nebro
Observational Research


The aims of this study were to evaluate adherence of rheumatoid arthritis (RA) patients to biological disease-modifying antirheumatic drugs (bDMARDs), identify potential risk factors, and analyze the discriminative ability of the Morisky–Green test (MGT) to detect bDMARD nonadherence. One hundred and seventy-eight adult RA patients treated with bDMARDs were included. Adherence was measured using the medication possession ratio (MPR) of the previous 6 months. An MPR >80% was considered good adherence. Patient demographics, clinical characteristics, and MGT scores were assessed through a standardized clinical interview at the cross-sectional date. One-hundred and twelve patients (63%) were taking subcutaneous bDMARDs, while 66 (37%) were taking intravenous drugs. One-hundred fifty-eight (88.8%) showed good adherence to bDMARDs, while 79 (61.2%) also correctly took concomitant conventional synthetic DMARDs (csDMARDs). In logistic regression models, nonadherence to bDMARDs was associated with higher disease activity [odds ratio (OR) 1.45; 95% CI, 1.03–2.03; p = 0.032] and subcutaneous route (OR 3.70; 95% CI 1.02–13.48; p = 0.040). MGT accurately identified an MPR >80% of bDMARDs in 76.9% of the patients. A sensitivity of 78%, specificity of 70%, positive predictive value of 95.3%, negative predictive value of 28.5%, positive likelihood ratio (LR) of 2.6, and negative LR of 0.3% were obtained. Adherence may be good for bDMARDs but is low for csDMARDs. Low adherence for bDMARDs is associated with poorer disease control during the past 6 months and use of subcutaneous route. These findings should alert doctors to consider possible low adherence before declaring treatment failure.


Rheumatoid arthritis Adherence Biological disease-modifying antirheumatic drugs (bDMARDs) 



We are grateful to Olga Pérez (from the FIMABIS) for her statistical advice. This research was supported by FIMABIS.

Compliance with ethical standards

Conflict of interest

Natalia Mena-Vazquez has received a speaker honorarium from company MSD and ROCHE. Sara Manrique-Arija has received a speaker honorarium from company MSD, Pfizer and Abbvie. Lucía Yunquera-Romero declares that she has no conflict of interest. Inmaculada Ureña-Garnica declares that she has no conflict of interest. Dr Marta Rojas-Gimenez has received a speaker honorarium from company MSD. Carla Domic has received a speaker honorarium from company MSD. Francisco Gabriel Jimenez-Nuñez has received a speaker honorarium from company MSD, Pfizer and Abbvie. Antonio Fernandez-Nebro has received a speaker honorarium from company MSD, ROCHE and Pfizer.

Financial supporter

Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud (FIMABIS). There were no financial support or other benefits from commercial sources for the work reported on in the manuscript, or any other financial interests that any of the authors may have, which could create a potential conflict of interest or the appearance of a conflict of interest with regard to the work.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Natalia Mena-Vazquez
    • 1
  • Sara Manrique-Arija
    • 1
  • Lucía Yunquera-Romero
    • 2
  • Inmaculada Ureña-Garnica
    • 1
  • Marta Rojas-Gimenez
    • 1
  • Carla Domic
    • 1
  • Francisco Gabriel Jimenez-Nuñez
    • 1
  • Antonio Fernandez-Nebro
    • 1
  1. 1.UGC de Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de MálagaMálagaSpain
  2. 2.Hospitalary pharmacy, Hospital Regional Universitario de MálagaMálagaSpain

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