Adherence to etanercept therapy in rheumatoid arthritis patients during 3 years of follow-up

PLoS One. 2018 Oct 9;13(10):e0205125. doi: 10.1371/journal.pone.0205125. eCollection 2018.


Objectives: To determine the percentage non-adherence to etanercept in patients with rheumatoid arthritis during three years of follow-up.

Methods: During study visits in this prospective cohort study, blood samples were taken to determine serum etanercept concentrations using ELISA and patients were asked if they had missed an etanercept dose, at which date and for what reason. Non-adherence was defined as serum etanercept concentration <0.1 μg/mL and no valid reason to miss the prescribed etanercept dose.

Results: In total, 292 consecutive patients treated with etanercept were included. Most patients had a valid reason to miss their etanercept dose (25/37). In total 12 out of 292 patients (4.1%, 95% confidence interval 2.2-7.2) were non-adherent during the 3 year period. In a small percentage of patients (3.4%, 95% confidence interval 0.8-10.4) who failed to respond to etanercept therapy, according to their rheumatologist, this was associated with inadequate exposure to etanercept and thus non-adherence.

Conclusion: In this study, adherence to etanercept therapy was measured using serum etanercept concentration. In most patients an absent etanercept concentration was due to a medical reason. Furthermore, the majority of patients were adherent to etanercept therapy and had adequate drug exposure. In total, only 12 out of 292 patients (4.1%) were non-adherent during 3 years of follow-up. These findings highlight that only a small minority of patients are non-adherent to etanercept treatment, especially compared to adherence rates of other drugs. However, physicians should be aware that in patients failing to respond to treatment, non-adherence is a possible cause.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antirheumatic Agents / blood
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / blood
  • Arthritis, Rheumatoid / drug therapy*
  • Etanercept / blood
  • Etanercept / therapeutic use*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Medication Adherence*
  • Middle Aged
  • Prospective Studies


  • Antirheumatic Agents
  • Etanercept

Associated data

  • figshare/10.6084/m9.figshare.7121570

Grant support

The cohort study was partially financed by AbbVie (ACA-NETH-05-012). Measurement of drug concentrations was sponsored by Pfizer (WI180-353). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.