034. Anxiety and Depression are Associated with Non-Adherence to Methotrexate in the First 6 Months of Treatment in a Rheumatoid Arthritis Population

Background: MTX is the first-line treatment for RA in the UK, however response is not universal and non-adherence may partially explain poor response. Previous estimates of adherence have not differentiated between periods of non-adherence and those in which patients adhere to medical advice to miss a dose of MTX. This study aimed to conduct an in-depth descriptive analysis of adherence to MTX during the first 6 months and to identify potential predictors of non-adherence. Methods: Patients were recruited to the Rheumatoid Arthritis Medication Study (RAMS), a multicentre prospective cohort of incident MTX users with a diagnosis of RA or inflammatory polyarthritis in the UK. At baseline, clinical history, DAS for 28 joints, disease duration, HAQ, visual analogue scales (VAS) general well-being, pain & fatigue, demographic, alcohol and smoking data were collected. In addition, patients completed The Beliefs about Medicines Questionnaire (BMQ), Brief Illness Perceptions Questionnaire (BIPQ), Hospital Anxiety and Depression Scale (HADS), and the EQ-5D. To measure adherence during the first 6 months after MTX commencement patients completed a weekly MTX diary reporting any missed doses and reasons. Adherence was calculated as the proportion of weeks patients took MTX as directed by their consultant, including weeks when MTX wasn’t taken following medical advice. Nonadherence was defined as ≥1 dose missed against medical advice. Univariate regression analyses were applied to test the association between possible predictors and non-adherence. Results: 552 patients provided 13 253 weeks of diary data, 12 564 weeks (97.4%) were adherent. 142/552 (25%) patients reported 342 non-adherent weeks (2.6%), 110/552 (20%) patients reported 347 adherent weeks (2.6%) where MTX was missed following medical advice. Reasons for non-adherence (%non-adherent weeks) included; feeling unwell (63.2%), forgot (10.9%), drug holiday (10.4%), ran out (8.4%), changed dose (7.3%). Higher tender joint count, fatigue, depression & anxiety scores at baseline predicted non-adherence at 6 months.