Alahmadi, Fahad, Simpson, Andrew, Gomez, Christina, Wheelock, Craig, Shaw, Dominick, Fleming, Louise, Roberts, Graham, Riley, John, Bates, Stewart, Sousa, Ana R., Knowles, Richard, Bansal, Aruna, Corfield, Julie, Pandis, Ioannis, Sun, Kai, Bakke, Per, Caruso, Massimo, Chanez, Pascal, Dahlen, Babro, Horvath, Ildiko, Krug, Norbert, Montuschi, Paolo, Sandstrom, Thomas, Singer, Florian, Wagers, Scott, Adcock, Ian, Djukanovic, Ratko, Chung, Kian, Sterk, Peter J., Dahlen, Sven-Erik and Fowler, Stephen J. (2018) Measures of adherence in patients with severe asthma prescribed systemic steroids in the U-BIOPRED cohort. European Respiratory Journal, 52 (suppl 62), [PA3992]. (doi:10.1183/13993003.congress-2018.PA3992).
Abstract
Introduction: Rates of sub-optimal adherence to medications in asthma range up to 70%; the impact in severe asthma is likely to be particularly high. We measured self-reported adherence in participants in the U-BIOPRED cohort prescribed daily prednisolone using the Medication Adherence Response Scale (MARS), and compared to measured urinary prednisolone and metabolites in order to determine: 1. the prevalence of suboptimal adherence by each method; 2. the ability of MARS to predict urinary steroid detection. Methods: Participants completed the MARS, and/or provided urine samples (analysed for prednisolone and metabolites by LCMS). The performance characteristics of the MARS predicting undetected urinary steroid were calculated in the subgroup having both tests. Results: 181 participants currently taking regular oral corticosteroids were included, 59% female, mean (SD) age 54(12)yrs, FEV1 64.7(20.4)% predicted. Sub-optimal adherence (MARS score < 4.5) was reported in 62 participants, and 76 did not have detectable urinary prednisolone or metabolites. Good adherence by both methods was detected in only 52 participants (34%, see table). There was no difference in daily prednisolone dose between detectable and undetectable metabolites groups (p=0.848). Conclusion: Low levels of adherence to treatment in severe asthma is a common problem, when measured either directly or self-reported. There was very poor agreement (48% concordance) between these two methods, and we suggest that, for now both approaches should be used.
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