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\begin{document}

\title{The correlation between four adherence measurements methods in patients
with rheumatoid arthritis using methotrexate}



\author[1]{Renske Hebing}%
\author[2]{Nada Elhendy}%
\author[2]{Eva Geel}%
\author[3]{Milou Heuckelum}%
\author[2]{Michael Nurmohamed}%
\author[4]{Bart van den Bemt}%
\affil[1]{Amsterdam Rheumatology and Immunology Center}%
\affil[2]{Reade Hoofdlocatie Dr Jan van Breemenstraat}%
\affil[3]{Maasstad Hospital}%
\affil[4]{Sint Maartenskliniek}%


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  \date{June 06, 2024}


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\begin{abstract}
Objective Methotrexate (MTX) is the cornerstone in the treatment of
rheumatoid arthritis (RA) patients. However, adherence to MTX therapy is
not optimal, and instruments to assess medication non-adherence are
warranted. To date there is no consensus on the best method to determine
adherence to MTX. The aim of this study was to assess the correlation
between adherence assessed with a Medication Event Monitoring System
(MEMS) versus pill count, MTX-polyglutamate (PG) concentration and
Compliance-Questionnaire-Rheumatology (CQR) in patients with established
RA. Second, the correlations between these methods and the Disease
Activity Scores of 28 joints (DAS28) were examined. Methods Adult RA
patients currently treated with MTX were included. Multivariable linear
and logistic regression were used, with adherence assessed with MEMS as
dependent variable versus pill count, MTX-PG concentrations, CQR as
independent variables, and DAS28 versus each of the four adherence
measurements. Covariates were included, such as comedication, age and
use of corticosteroids. Results 190 consecutive RA patients were
included. Pill count was correlated with adherence assessed with MEMS
(linear regression, \selectlanguage{greek}β \selectlanguage{english}= .690, p = \textless{}.001), whereas CQR and
MTX-PGs were not. Logistic regression confirmed the correlation between
dichotomized adherence and pill count only (\selectlanguage{greek}β \selectlanguage{english}= 5.64, p=
\textless{}.001). No other correlations were found, neither for all
adherence outcomes and DAS28. Conclusion Measuring adherence with MEMS
is correlated with pill count, whereas other methods were not correlated
with MEMS, nor with DAS28. Pill count can be used to estimate adherence
to MTX therapy, in case MEMS is not achievable.%
\end{abstract}%



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