Romatoid artrit hastalığında ilaç uyumu, tedaviye devam etme ve tedavinin kesilmesi: tek merkezli gerçek dünya çalışması

Year 2025, Volume: 7 Issue: 6, 716 - 724, 26.10.2025

Zehra Özsoy , Mustafa Ekici , Emrach Chousein , Özlem Şahan Güven , İhsan Ertenli

https://doi.org/10.38053/acmj.1761804

Abstract

Amaçlar: Romatoid artrit (RA) tedavisi, hastalık modifiye edici antiromatizmal ilaçların (DMARD) düzenli kullanımına bağlıdır, ancak gerçek hayatta tedaviye uyum ve devamlılık optimum düzeyde değildir. Tedaviye uyumsuzluk hastalık kontrolünü zorlaştırırken, uzun süreli tedavi enfeksiyon riskini artırabilir. Türk RA hastalarında bu konudaki veriler sınırlıdır.
Yöntem: Bu retrospektif çalışmada, 2010 ACR/EULAR RA kriterlerini karşılayan ve Hacettepe Üniversitesi'nde en az 6 ay takip edilen 107 yetişkin hasta analiz edildi. Reçete edilen DMARD dozunun ≥%80'ini almak olarak tanımlanan uyum, hasta bildirimi ve dosya incelemesi yoluyla değerlendirildi. Tedaviye devam etme, tedaviyi bırakma nedenleri ve klinik sonuçlar belgelendi. Hastalık aktivitesi DAS28-CRP ile ölçüldü. Çok değişkenli lojistik regresyon, uyumsuzluk, tedaviyi bırakma ve enfeksiyon öngörücülerini belirledi.
Bulgular: Genel olarak, %28,0'ı düzensiz ilaç kullanımı bildirirken, %42,1'i en az bir csDMARD'ı bırakmıştı. Yaygın uyumsuzluk nedenleri arasında takipsizlik (%31,8) ve yan etki endişeleri (%27,3) bulunmakta idi. Uyumsuzluk nedenlerinin bağımsız değişkenleri arasında uzun takip süresi (OR 1,040, %95 GA 1,005-1,076), sık doktora başvurma VAS'ı (OR 1,035, %95 GA 1,006-1,065) ve hidroksiklorokin kullanımı (OR 4,733, %95 GA 1,450-15,543) yer almakta idi. Tedaviye uyumsuzluk, en az bir csDMARD'ın kesilmesi ile güçlü ilişkili (OR 9,22, %95 CI 2,12-39,87) iken daha düşük BMI ile arasında sınırda bir ilişki saptandı (OR 0,87, %95 CI 0,76-1,00). Tedavi uyumu, ilginç şekilde yüksek enfeksiyon riskiyle ilişkilendirildi (OR 4,163, %95 CI 1,030-16,833). Sülfasalazin en yüksek kesilme oranına (%80,0) sahipti ve en kısa ortanca tedavi tutma süresini (9,5 ay) gösterdi.
Tartışma: RA'da tedaviye uyumsuzluk sık görülür ve csDMARD tedavisinin kesilmesiyle yakından ilişkilidir; bu da davranışsal ve algısal engellerin ele alınması gerektiğini vurgulamaktadır. Uyum ve enfeksiyonlar arasındaki ilişki, uzun süreli bağışıklık baskılanması olan hastalarda dikkatli izlemenin önemini vurgulamaktadır. Sülfasalazinin bu durumda uzun süreli tedavi için daha az uygun olabileceğini düşündürmektedir.

Keywords

Romatoid artrit , İlaç uyumu , DMARD kalıcılığı , Tedavinin kesilmesi

Medication adherence, treatment persistence, and discontinuation in rheumatoid arthritis: a single-center real-world study

Abstract

Aims: Rheumatoid arthritis (RA) management depends on sustained use of disease-modifying antirheumatic drugs (DMARDs), yet adherence and persistence remain suboptimal in real life. Non-adherence may undermine disease control, while long-term therapy can increase infection risk. Data on these parameters in Turkish RA patients are scarce.
Methods: In this retrospective study, 107 adults fulfilling 2010 American College of Rheumatology (ACR)-European League Against Rheumatism (EULAR) RA criteria and followed ≥6 months at Hacettepe University were analyzed. Adherence, defined as intake of ≥80% prescribed DMARDs doses, was assessed via patient self-report and chart review. Persistence, discontinuation reasons, and clinical outcomes were documented. Disease activity was measured with disease activity score in 28 joints with C-reactive protein (DAS28-CRP). Multivariate logistic regression identified predictors of non-adherence, discontinuation, and infection.
Results: Overall, 28.0% reported irregular medication use, and 42.1% discontinued at least one conventional synthetic DMARDs (csDMARDs). Common non-adherence reasons were lack of routine (31.8%) and adverse effect concerns (27.3%). Independent predictors of non-adherence included longer follow-up (OR 1.040, 95% CI 1.005–1.076), higher baseline physician Visual Analog Scale (VAS) (OR 1.035, 95% CI 1.006–1.065), and hydroxychloroquine use (OR 4.733, 95% CI 1.450–15.543). Non adherence strongly predicted the discontinuation of at least one csDMARD (OR 9.22, 95% CI 2.12–39.87), while lower body-mass index (BMI) showed a borderline association with treatment discontinuation (OR 0.87, 95% CI 0.76–1.00). Adherence was paradoxically associated with higher infection risk (OR 4.163, 95% CI 1.030–16.833). Sulfasalazine showed the highest discontinuation rate (80.0%) and shortest median retention (9.5 months).
Conclusion: Non-adherence is frequent and closely linked to csDMARD discontinuation in RA, underscoring the need to address behavioral and perceptual barriers. The association between adherence and infections highlights the importance of vigilant monitoring in patients with prolonged immunosuppression. Drug-specific patterns suggest sulfasalazine may be less suitable for long-term therapy in this setting.

Keywords

Rheumatoid arthritis , medication adherence , DMARD persistence , treatment discontinuation

Ethical Statement

The study was approved by the Hacettepe University Ethics Committee (Approval No: GO 22/877).

Supporting Institution

none

Thanks

none

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