Unanswered DMARD concerns revealed in medicines helpline calls

Arthritis patients’ often exaggerated fears about DMARDS are reflected in calls to a national medicines call centre, which show they mostly involve questions about perceived risks.

An analysis of 1,547 DMARD-related calls to the NPS Medicines Line between 2002 and 2010, the top three enquiry types were about side-effects (25.2%), interactions (19.4%), and risk/benefit assessment and comparison among DMARDs (12.1%).

At the time, cDMARDs generated much more interest than bDMARDs (82% v 18% of calls), with questions such as “will methotrexate cause hair loss?”

Questions about bDMARDs were less likely to be about safety and more likely to be about how they worked, indications, efficacy and logistical issues (“How can I obtain an emergency supply of Enbrel (etanercept) when my specialist is away?”).

Patients were motivated to seek advice from the call centre due to inadequate information (44%), needing a second opinion (23.6%), concern about a worrying symptom (18.8%), conflicting information (6.9%), or information overload (2.3%).

A narrative analysis of the calls identified some of the sub-themes regarding medication safety included:

  • Clarification on a potential side effect of a specified DMARD (“Can methotrexate cause facial skin lesions?)
  • Information about the general safety of a specified DMARD (“What are the side effects of adalimumab?”)
  • Reassurance on the use of a specific DMARD (“Can I take my methotrexate dose today if I have just had a local anaesthetic at my dentist?”)
  • Potential interactions of other medicines with a specified DMARD (“Can hydroxychloroquine be taken with diclofenac?”)
  • Potential interactions of complementary medicines with a specified DMARD (“Can I take St John’s Wort if I am on Mabthera (rituximab)?”)
  • Lifestyle issues while on a specified DMARD (“Would there be an interaction between methotrexate and alcohol I had?”

Queries about possible interactions between DMARD and other medicines most commonly involved NSAIDs, cardiovascular drugs, central nervous system agents and vaccines.

People also called with questions about timing, dose and administration of their DMARD, including in relation to other concomitant drugs, strategies for withdrawal and reintroduction of a DMARD, managing a potential adverse event or managing their DMARD in relation to situations such as elective surgery.

Another issue of significant concern for patients was the potential impact of a DMARD on reproductive health, with questions such as whether they would affect fertility or cause birth defects.

The study authors, from the University of Queensland’s School of Pharmacy, said the calls demonstrate that consumers have many unanswered questions and considerable uncertainty regarding their DMARDs.

“These callers had a genuine medicines information need unanswered in their usual physician-patient encounters or through other traditional sources where their uncertainty was sufficient to motivate them to actively help-seek,” they wrote.

“Understanding the common themes driving medicines information-seeking related to DMARDs is key to addressing consumer information gaps and improving overall DMARD use and adherence,” they concluded.

The findings are published in BMC Rheumatology.

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