Adherence to treatment of children and adolescents recently diagnosed with auto-immune Rheumatic Diseases during the COVID-19 pandemic

Silva, Ilana Izidoro da; Miotto e Silva, Vanessa Bugni; Carrara, Fernanda Souza Angotti; Piotto, Daniela Gerent Petry; Len, Claudio Arnaldo; Terreri, Maria Teresa

doi:10.1016/j.jped.2022.11.014

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Sumário

Original article • J. Pediatr. (Rio J.) 99 (3) • May-Jun 2023 • https://doi.org/10.1016/j.jped.2022.11.014 copy

Adherence to treatment of children and adolescents recently diagnosed with auto-immune Rheumatic Diseases during the COVID-19 pandemic^✰ ✰ Institution or service with which the work is associated for indexing in Index Medicus/MEDLINE: Universidade Federal de São Paulo (UNIFESP).

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives

Adherence problems have a great impact on auto-immune Rheumatic Diseases (AIRD). The COVID-19 pandemic may have worsened treatment adherence. The aims of this study were to measure treatment adherence to identify an earlier risk of poor adherence and measure families’ satisfaction with the health service during the pandemic.

Methods

Prospective observational study with 50 parents/children and adolescents with recent AIRD diagnosis. Initially, they answered questions (demographic data, disease) and completed the Pediatric Rheumatology Adherence Questionnaire (PRAQ), after 6 months they completed the Morisky-Green Test (MGT), Brief Medication Questionnaire (BMQ), Compliance Questionnaire for Rheumatology (CQR-19) and Pediatric Quality of Life Inventory Questionnaire 3.0 (PedsQl^TM-SSS). The patient's medical records from the previous 12 weeks were reviewed for global and medication adherence data.

Results

The mean global adherence score was 94.3 ± 10.0, for medication adherence 97.3 ± 9.3, and for PRAQ questionnaire 5.2 ± 1.5. The authors observed agreement between MGT, BMQ, CQR-19, PedsQL^TM-SSS scores and medication adherence rate, but not with global adherence rate. There were no associations between demographic characteristics, disease diagnosis, and adherence. No associations between PRAQ scores and values and global/medication adherence rates were observed. No variables were shown to be predictors of good adherence. The mean PedsQL^TM-SSS rate was 92.1 ± 6.8.

Conclusion

The high values of MGT, BMQ, CQR-19 questionnaire scores were in agreement with the medication adherence rate. Despite the pandemic, the global and medication adherence rates were good. It was not possible to demonstrate the PRAQ's predictive power. The authors weren't able to establish an association between families’ satisfaction and treatment adherence rates.

Keywords
Adherence to treatment; Auto-immune rheumatic diseases; COVID-19

	N= 50 patients
Female gender, n (%)	30 (60.0)
Age (years)
Mean ± SD	10.2 ± 5.2
Median (minimum - maximum)	11.0 (1.0 - 18.0)
Disease, n (%)
JSLE	22 (44.0)
JIA	21 (42.0)
JDM	5 (10.0)
JSSc	1 (2.0)
TAK	1 (2.0)
Disease activity - 1st evaluation, n (%)
Active	46 (92.0)
Inactive	4 (8.0)
Disease activity - 2nd evaluation, n (%)
Active	37 (74.0)
Inactive	13 (26.0)
Quantity of medication - 1st evaluation
Mean ± SD	4.8 ± 2.5
Median (minimum - maximum)	4.0 (1.0 - 12.0)
Quantity of medication - 2nd evaluation
Mean ± SD	5.0 ± 2.7
Median (minimum - maximum)	5.0 (0.0 - 11.0)
Medications used at the 1st evaluation, n (%)
Conventional DMARDs	31 (13.1)
Biological DMARDs	0 (0.0)
Immunosupressants	12 (5.1)
Other medications*	194 (81.8)
Medications used at the 2nd evaluation, n (%)
Conventional DMARDs	28 (11.4)
Biological DMARDs	1 (0.4)
Immunosupressants	16 (6.5)
Other medications*	200 (81.7)

	Global Adherent
	Adherent (n= 45)	Non adherent (n= 5)	p value
Gender, n (%)			0.636
Female	26 (57.8)	4 (80.0)
Male	19 (42.2)	1 (20.0)
Age (years)			0.446
mean ± SD	10.4 ± 5.1	8.4 ± 5.8
median (minimum - maximum)	11.0 (1.0 - 18.0)	9.0 (2.0 - 15.0)
Disease, n (%)			0.364
JSLE	21 (46.7)	1 (20.0)
JIA	17 (37.8)	4 (80.0)
JDM	5 (11.1)	0 (0.0)
JSSc	1 (2.2)	0 (0.0)
TAK	1 (2.2)	0 (0.0)
PRAQ 1st evaluation			0.574
Mean ± DP	5.2 ± 1.5	6.0 ± 3.3
Median (minimum - maximum)	5.0 (2.0 - 9.0)	5.0 (2.0 - 11.0)
MGT 2nd evaluation - classification, n (%)			0.072
High	33 (73.3)	2 (40.0)
Medium	12 (26.7)	2 (40.0)
Low	0 (0.0)	1 (20.0)
BMQ 2nd evaluation - classification, n (%)			0.138
Adherent	40 (88.9)	3 (60.0)
Non- adherent	5 (11.1)	2 (40.0)
CQR-19 2nd evaluation-classification, n (%)			0.103
Adherent	41 (91.1)	3 (60.0)
Non-adherent	4 (8.9)	2 (40.0)
PedsQL^TM-SSS 2nd evaluation			0.646
Mean ± SD	95.9 ± 4.5	95.8 ± 3.8
Median (minimum - maximum)	97.0	95.8
Median (minimum - maximum)	(83.0 −100.0)	(89.7 - 100.0)

	Medication adherent
	Adherent (N= 47)	Non-adherent (N= 3)	p value
Gender, n (%)			1.000
Female	28 (59.6)	2 (66.7)
Male	19 (40.4)	1 (33.3)
Age (years)			0.526
Mean ± SD	10.1 ± 5.3	12.3 ± 3.1
Median (minimum - maximum)	11.0 (1.0 - 18.0)	13.0 (9.0 - 15.0)
Disease, n (%)			0.757
JSLE	21 (44.7)	1 (33.3)
JIA	19 (40.4)	2 (66.7)
JDM	5 (10.6)	0 (0.0)
JSSc	1 (2.1)	0 (0.0)
TAK	1 (2.1)	0 (0.0)
PRAQ 1st evaluation			0.491
Mean ± SD	5.3 ± 1.8	5.7 ± 1.2
Median (minimum - maximum)	5.0 (2.0 - 11.0)	5.0 (5.0 - 7.0)
TMG 2nd evaluation - classification, n (%)			0.005
High	35 (74.5)	0 (0.0)
Medium	12 (25.5)	2 (66.7)
Low	0 (0.0)	1 (33.3)
BMQ 2nd evaluation - classification, n (%)			0.048
Adherent	42 (89.4)	1 (33.3)
Non-adherent	5 (10.6)	2 (66.7)
CQR-19 2nd evaluation-classification, n (%)			0.035
Adherent	43 (91.5)	1 (33.3)
Non-adherent	4 (8.5)	2 (66.7)
PedsQL^TM-SSS 2nd evaluation			0.246
Mean ± SD	96.0 ± 4.4	94.2 ± 3.9
Median (minimum - maximum)	97.0 (83.0 -100.0)	95.8 (89.7 - 97.0)

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E-mail: jped@jped.com.br

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[1] ⁎ Corresponding author. E-mail: ilanaizidoro@terra.com.br (I.I. da Silva).

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Adherence to treatment of children and adolescents recently diagnosed with auto-immune Rheumatic Diseases during the COVID-19 pandemic✰ ✰ Institution or service with which the work is associated for indexing in Index Medicus/MEDLINE: Universidade Federal de São Paulo (UNIFESP).

Abstract

Objectives

Methods

Results

Conclusion

Adherence to treatment of children and adolescents recently diagnosed with auto-immune Rheumatic Diseases during the COVID-19 pandemic^✰ ✰ Institution or service with which the work is associated for indexing in Index Medicus/MEDLINE: Universidade Federal de São Paulo (UNIFESP).