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An investigation of adherence to statin therapy in patients with rheumatoid arthritis

Binkley, George Michael

[Thesis]. Manchester, UK: The University of Manchester; 2016.

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Abstract

BackgroundRheumatoid arthritis (RA) patients are more likely to experience a cardiovascularevent (CVE) than the general population. This is a result of atherosclerotic diseaseaugmented by systemic inflammation. HMG-CoA (3-hydroxy-3-methylglutarylcoenzyme A) reductase inhibitors (statins) lower the risk of CVEs;further, pleiotropic effects are of clinical relevance for RA disease activity. Manypatients do not achieve ideal clinical outcomes because of poor medicationadherence. This study sought to determine the rates and predictors of adherence inthe TRACE-RA population.MethodsData collected from the Trial of Atorvastatin for the primary prevention ofCardiovascular Events in patients with Rheumatoid Arthritis (TRACE-RA) wereused to meet these aims. Two thousand nine hundred and eighty six patients from102 centres were randomised to receive either atorvastatin or placebo. Adherencewas determined up to 3, 6 and 12 months using data on pill counts and self-reports.Rates and responses were dichotomised as adherent (>80% consumption or ‘Mosttablets consumed’) and non-adherent (<80% consumption or ‘Some/None tabletsconsumed’). Univariate logistic regression analysis and multivariate logisticregression analysis were performed to determine predictors of adherence for patientswith complete data in both arms of TRACE-RA and for those solely in theatorvastatin arm. The multivariate models were adjusted for age and gender.ResultsAdherence to trial medication was 49.4%, 49.1% and 50.1% up to 3, 6 and 12months respectively. No significant differences for the rates of adherence wereobserved between arms. Patients who consumed alcohol on a monthly or less basis(OR=0.65, 95%CI 0.42-0.97) were less likely to adhere to the allocated TRACE-RAintervention than patients who never consumed alcohol. Patients who reported‘extreme pain/ discomfort’ were 67% more likely to adhere to the TRACE-RAintervention than those who reported no pain/ discomfort (OR=1.67, 95%CI 0.96-2.90). In the atorvastatin arm, patients with a high disease activity were moreadherent towards statin therapy than patients in remission (OR=1.64, 95%CI 0.83-3.24).ConclusionAdherence to trial medication was sub-optimal in TRACE-RA. This research hasimportance for adherence in RA populations, predictors of adherence to statintherapy, and interventions such as counselling or adherence programmes.Underlying attitudes, motivations and beliefs of non-adherent patients requirefurther examination.