SUMMARY BackgroundThe development of alcohol dependence is associated with significant morbidity and mortality. For the majority of affected people the most appropriate goal, in terms of drinking behaviour, is abstinence from alcohol. Psychosocial intervention is the mainstay of the treatment but adjuvant pharmacotherapy is also available and its use recommended. AimTo provide an updated analysis of current and potential pharmacotherapeutic options for the management of alcohol dependence. In addition, factors predictive of therapeutic outcome, including compliance and pharmacogenetics, and the current barriers to treatment, including doctors' unwillingness to prescribe these agents, will be explored. MethodsRelevant papers were selected for review following extensive, language-and date-unrestricted, electronic and manual searches of the literature. ResultsAcamprosate and naltrexone have a substantial evidence base for overall efficacy, safety and cost-effectiveness while the risks associated with the use of disulfiram are well-known and can be minimised with appropriate patient selection and supervision. Acamprosate can be used safely in patients with liver disease and in those with comorbid mental health issues and co-occurring drug-related problems. A number of other agents are being investigated for potential use for this indication including: baclofen, topiramate and metadoxine. ConclusionPharmacotherapy for alcohol dependence has been shown to be moderately efficacious with few safety concerns, but it is substantially underutilised. Concerted efforts must be made to remove the barriers to treatment in order to optimise the management of people with this condition. Aliment Pharmacol Ther

Aim: To determine the prevalence of the use of complementary medicine in patients with systemic lupus erythematosus (SLE). Method: A prospective survey was conducted of 132 patients using a standard questionnaire. Results: Of the 132 patients, 15.2% were on alternative therapy and 56.7% were taking food supplements. The common types of alternative therapy taken were oral traditional herbs (50%) and noni juice (20%). Vitamin C, calcium, vitamin E, vitamin B, Spirulina, evening primrose oil, fish oil and multivitamins were the commonest food supplements. There was no significant relationships between taking alternative treatment and educational level (P = 0.16), income (P = 0.05) or race (P = 0.42) of the patients. The majority of these patients took these therapies or supplements for up to 1 year. Up to 70% of the patients had not consulted a doctor before taking these therapies, with immediate family members and friends being the main sources of recommendation. The majority of patients spent RM50−RM500 (US$13−US$132) for 2 months’ supply of medications. In conclusion, 15.2% of SLE patients in our study were on alternative therapy and 57.6% on food supplements. Conclusion: Physicians should be aware of these practices which should be taken into account during the history‐taking and subsequent management of the patients.

BackgroundNonadherence to treatment in rheumatoid arthritis (RA) has been shown to negatively impact on treat to target goals and disease outcomes. Identifying and targeting potential factors influencing nonadherence is therefore crucial in optimising patient management.ObjectivesTo determine factors associated with nonadherence in patients with RA.MethodsAn electronic search was performed by two independent reviewers using MEDLINE and focusing on articles published from inception to January 2017. The search strategy combined the thesaurus (MeSH) and expanded keyword searches of two concepts: RA and treatment adherence. Inclusion criteria included observational studies and clinical trials examining potential factors associated with nonadherence. Exclusion criteria included articles not in English or without online access and those with a focus on forms of therapy other than medication. Agreement between raters at the screening stage was high (97%, kappa=.87).ResultsThe primary search yielded 1411 papers, from which 75 were eventually identified as suitable for full review (Figure). Of the 75 papers, 65 were based on observational studies and 10 on clinical trials. Factors associated with nonadherence were broadly categorized into patient-related factors (socio-demographic factors, patient perceptions [beliefs/knowledge/attitudes]), disease-related factors (disease duration/severity, comorbidities, functional disability) and treatment-related factors (drug type/ method of administration/duration/regimen complexity, combination therapy). The majority (70% of all included studies) of studies reported significant associations between patient-driven factors and nonadherence. Adherence was found to be negatively associated with socioeconomic status, health literacy, and beliefs/perceptions/knowledge of the disease and treatment. Studies reported poorer mental health state (n=6) and greater disability/pain (n=7) to be implicated in nonadherence. Disease duration was largely non-significant in treatment adherence, although a few studies reported a negative correlation (n=3). Combining biologics with DMARDs was associated with improved adherence. However, considering non-biologic DMARDs only, adherence rates were higher amongst monotherapy users. One study identified polypharmacy to be negatively associated with adherence. Drug side effects were associated with nonadherence (n=7).ConclusionsPatient-related factors including personal perceptions were among key contributors to nonadherence to medication in RA patients. This highlights the need for addressing patient-driven perceptions, along with disease and treatmentAcknowledgementsMany thanks to Simon Coates and Julia Garthwaite of Library Services at University College London for their advice.Disclosure of InterestNone declared