Abstract
Purpose :
To investigate the adherence rate (AR) to steroid-sparing immunosuppressive therapy (IMT) in treatment of chronic noninfectious inflammatory eye disease (IED) using pharmacy refill information, impact of adherence on disease control, and association between adherence determined by information in the medical record with pharmacy dispenses.
Methods :
Patients on IMT who followed in uveitis clinics for at least 2 years and attended an appointment in 2022 qualified for this study. Through retrospective chart review, demographics, type of IMT, and pharmacy information were collected over the most recent 1 year. Fill history for IMT was obtained from pharmacies and IMT infusion dates were noted. AR per IMT was calculated by number of dispenses divided by the number of expected prescriptions. For patients on multiple IMT, the average AR among all IMT determined overall AR. AR>85% defined adherence. Appointment attendance >85%, regular lab monitoring, and provider documentation determined adherence through the medical record. Disease control was determined by the most recent visit exam findings.
Results :
A total of 63 patients were included. The mean age was 49 years, 76.2% were female, 36.5% were Black/African American, and 96.8% were taking 1 or 2 IMTs. Types of IMT included Adalimumab (33.3%), Infliximab (36.5%), Methotrexate (39.7%), Mycophenolate (39.7%), Azathioprine (7.9%), and Other (9.5%). Pharmacy refill data was collected from 58 patients to determine the overall AR of 63.9%. 32.8% of patients were adherent and 67.2% were nonadherent. Of adherent patients, 94.7% had inflammation control. Of nonadherent patients, 82.1% had inflammation control; 76.9% were female, 56.4% were taking more than 1 IMT, and 82.1% identified as non-white race. Comparing adherence from information in the medical record to adherence by pharmacy refill data for each IMT per patient, 71.3% of IMT comparisons were congruent (adherent or nonadherent by both definitions).
Conclusions :
Patients taking IMT for more than 2 years demonstrated an AR of <65% based on pharmacy refill data, with the majority of patients achieving ocular quiescence. Using pharmacy information as an objective measure of adherence correlates with assessing adherence through information in the medical record.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.