Aim Recent studies have shown that good adherence cannot be taken for granted for patients on direct anticoagulants (DOACs). In this cross-sectional study, adherence among DOAC users was investigated and associations between beliefs about medication, perceived side effects and adherence were investigated. Methods We included 100 randomly selected adult DOAC users visiting one of the two participating Dutch community pharmacies in the summer of 2020. The self-reported adherence (primary outcome) was assessed with the Medication Adherence Rating Scale-5 (MARS-5). Beliefs about DOACs were assessed with the Beliefs about Medicine Questionnaire Specific (BMQ-S) while side effects were assessed with a self-developed questionnaire based on the Lareb Intensive Monitoring (LIM) system. Results Of the participants, 9% reported non-adherence on the MARS-5 (score <24). Associations were found between non-adherence and both reported side effects and side effect burden. Furthermore patients’ belief that DOACs have unpleasant side effects was associated with both non-adherence and more side-effects. No associations were found between adherence and either gender, indication, DOAC or dosage. Conclusion This study confirms that non-adherence in patients on DOACs is prevalent. We recommend that both physicians and pharmacists evaluate adherence and side effects with their DOAC patients on a regular base.

Aims: Little is known about usual care by physicians and pharmacy teams to support adherence to statins and whether the extent of this care is associated with adherence to statins. Objective of the study was to examine the relationship between the extent of adherence supporting activities of HCPs and patients’ adherence to statins. Methods: Cross-sectional study in 48 pharmacies and affiliated physicians’ practices, between September 3, 2014 and March 20, 2015. Patients visiting the pharmacy with a statin prescription from participating prescribers were invited to participate. Usual care to support adherence was assessed among HCPs with the Quality of Standard Care questionnaire about usual care activities to support adherence. Adherence to statins was assessed among patients with the MARS-5 questionnaire. The association between the extent of HCPs’ adherence supporting activities and patients’ adherence was examined by means of multilevel regression analysis. Results: 1,504 patients and 692 HCPs (209 physicians, 118 pharmacists and 365 pharmacy technicians) participated. No association was found between the extent of physicians’ adherence supporting activities and patients’ adherence to statins. The extent of adherence supporting activities by pharmacy teams in usual care was negatively associated with patients’ adherence to statins (B coefficient -0.057 (95%CI: 0.112-0.002). Conclusions: This study suggests that there is no positive relationship between the extent of HCPs’ adherence supporting activities in usual care and patients’ adherence to statins. Other methods than questionnaires (e.g. electronic monitors (to assess adherence) and observations (to assess usual care) should be applied to confirm the results of this study

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, β = .690, p = <.001), whereas CQR and MTX-PGs were not. Logistic regression confirmed the correlation between dichotomized adherence and pill count only (β = 5.64, p= <.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.

Aims: The objective of this retrospective cohort study was to provide an overview of the utilization of originator and biosimilar infliximab in the Netherlands. Methods: All infliximab dispensings were selected from the PHARMO In-patient Pharmacy Database from 2002-2018. Descriptive analyses were performed in order to characterise initiators and to describe switching patterns over time. Results: Overall, 3,840 patients with 61,274 infliximab dispensings were identified. 2,496 patients initiated an originator infliximab and 777 patients initiated a biosimilar infliximab. Overall, 57% of the patients was female and mean age was 43.2 years. Both originators and biosimilars were mostly prescribed by gastroenterologists, followed by internists and rheumatologists. After market authorization of the first biosimilar the proportion of new patients initiating the biosimilar increased from 39% in 2015 to 91% in 2018. Out of 704 patients eligible for switching 34% switched. Among switchers, the proportion of females was 60% and mean age at index was 45.1 years. Among non-switchers, 55% was female and mean age was 39.8 years. The median time to switch was 1.7 years and switchers were most frequently initiated on infliximab by a rheumatologist (42%), while non-switchers were most frequently initiated by a gastroenterologist (42%). Conclusions: The results of this large population-based cohort show an increase in biosimilar initiation in daily clinical practice. The number of switchers remains relatively low as non-medical switch is not encouraged in the Netherlands.