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A Targeted Literature Review Examining Biologic Therapy Compliance and Persistence in Chronic Inflammatory Diseases to Identify the Associated Unmet Needs, Driving Factors, and Consequences

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Maniadakis N1, Toth E2, Schiff M3, Wang X4, Nassim M4, Szegvari B5, Mountian I5, Curtis JR6. Adv Ther. 2018 Aug 4. doi: 10.1007/s12325-018-0759-0. [Epub ahead of print]


Author information

1 Department of Health Services Organization and Management, National School of Public Health, Athens, Greece. nmaniadakis@esdy.edu.gr.

2 UCB Pharma, Brussels, Belgium. Emese.Toth@ucb.com.

3 University of Colorado School of Medicine, Denver, CO, USA.

4 ICON plc, Stockholm, Sweden.

5 UCB Pharma, Brussels, Belgium.

6 University of Alabama at Birmingham, Birmingham, AL, USA.


Chronic inflammatory diseases (CIDs) represent a substantial clinical and economic burden to patients, providers, payers and society overall. Biologics, such as tumor necrosis factor inhibitors (TNFi), have emerged as effective treatment options for patients with CIDs. However, the therapeutic potential of biologics is not always achieved in clinical practice, with results from studies examining the use of biologics in real-world settings suggesting lower levels of treatment effectiveness compared with clinical trial results. Using a targeted approach, this literature review demonstrates that compliance and persistence with biologic therapy is suboptimal and that this has implications for both clinical outcomes and treatment costs. The review identified a variety of predictors of treatment compliance and persistence, including increased age, female gender, presence of comorbidities, increased disease activity, longer disease duration, smoking, increased body mass index, higher biologic treatment dose, higher treatment cost and lower health-related quality-of-life scores. Patients often cited factors associated with medication delivery as a reason for non-compliance and non-persistence, and device-related improvements to treatment delivery were associated with higher rates of compliance and persistence. The articles identified in this review provide insights that have the potential to help guide the development of new solutions to improve disease management and optimize treatment regimens. This has the potential to benefit patients' health by improving clinical outcomes and to reduce the burden to society by limiting the economic impact of patients' disease.