Measuring therapeutic adherence in systemic lupus erythematosus with electronic monitoring

Marengo, María Florencia; Waimann, Christian A.; Achaval, Sofia de; Zhang, H.; García-González, Araceli; Richardson, Marsha; Reveille, John D.; Suarez‐Almazor, María E.

doi:10.1177/0961203312447868

Cited by 75 publications

(91 citation statements)

References 28 publications

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“…Conversely, another study noted that higher education levels and those with lower income levels were associated with lower levels of adherence, although the population in this study were all of low socioeconomic status [28]. Depression is a consistent factor that negatively impacts adherence to medication in SLE [20, 23, 25, 27, 30]. SLE is thought to directly cause depression either by its direct impact on the brain and/or due to the chronic inflammatory process [32].…”

Section: Resultsmentioning

confidence: 88%

“…The use of MEMS is an objective method of assessing patient adherence to medications in SLE, which uses microchips to determine when patients have opened and closed their medication bottles [22, 27]. MEMS can be used for topical medications as well as oral medications, which allows for its utilization in topical treatments for SLE and CLE, which cannot be done in methods such as blood assays or pharmacy refill information [6].…”

Section: Resultsmentioning

confidence: 99%

“…Two studies noted no statistically significant difference in adherence to medication between white patients and ethnic minorities suffering from SLE. One study in Brazil [14] noted that white race was a factor that improved adherence, while others found that non-white race was a risk factor for lower adherence to hydroxychloroquine [14, 20, 22, 27]. While race and ethnicity have not been definitively shown to impact adherence to medication in SLE, socioeconomic factors can contribute [30].…”

Section: Resultsmentioning

confidence: 99%

“…Marengo et al [27] noted that while their patients improved after 2 years of adherence monitoring, there was no statistically significant association between adherence and SLE disease activity. Daleboudt et al [26] found no connection between disease severity and self-reported adherence rates.…”

Section: Resultsmentioning

confidence: 99%

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Adherence to Oral and Topical Medications in Cutaneous Lupus Erythematosus is not Well Characterized

Farhangian

Huang

Feldman

2015

Dermatol Ther (Heidelb)

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IntroductionTreatment adherence plays a large role in chronic dermatologic diseases and may play an important role in the outcomes of patients with cutaneous lupus erythematosus (CLE). We sought to gauge what is currently known about adherence to topical and oral medications in patients with CLE.MethodsA review of MEDLINE was performed using a combination of the phrases “adherence”, “compliance”, “lupus”, and “cutaneous”. Studies were hand searched and prospective and cross-sectional studies evaluating medication adherence in patients with CLE and systemic lupus erythematosus (SLE) were included.ResultsOnly two articles explored adherence in patients with CLE, while 17 articles discussed treatment adherence in patients with SLE. Depression was consistently cited as detrimental to adherence. The impact that race, ethnicity, and education has on adherence is unclear. Three studies noted a clear connection between adherence and disease activity, while two others did not. Few studies investigated methods that have improved adherence to treatment which have showed promise.ConclusionMuch of what we know about adherence to medication in patients with lupus is limited to SLE. Although cutaneous symptoms are among the most common manifestations of SLE, cutaneous disease is often managed at least in part with topical agents, and adherence to topical treatment was not assessed in any of the articles, though one study investigated sunscreen usage in patients with CLE. Understanding adherence in patients with CLE may help contribute to better CLE treatment outcomes.Electronic supplementary materialThe online version of this article (doi:10.1007/s13555-015-0075-4) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 88%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Adherence to Oral and Topical Medications in Cutaneous Lupus Erythematosus is not Well Characterized

Farhangian

Huang

Feldman

2015

Dermatol Ther (Heidelb)

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“…Different methods have been proposed to evaluate treatment adherence in SLE patients: self-reported, pill count, electronic monitoring (reviewed by Costedoat-Chalumeau et al) [53]. The methodological discrepancies among the studies performed on SLE patients do not allow drawing any conclusion about the best method to address this issue; only few studies used specific, validated questionnaire, the most reliable and useful screening tool for nonadherence in clinical setting [54,55]. However, it is unanimous that the lack of treatment adherence may reflect on disease activity [56].…”

Section: Adherence To Treatmentmentioning

confidence: 99%

Developing new evaluation methods in systemic lupus erythematosus

Ceccarelli

Alessadri

Scavalli

et al. 2015

International Journal of Clinical Rheumatology

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Monitoring systemic lupus erythematosus (SLE) requires comprehensive assessment\ud of disease activity, comorbidities, chronic damage and patients’ perspective of the\ud disease. This narrative review summarizes the innovative and currently available tools\ud to assess SLE patients in clinical research and routine practice setting focusing on what\ud is new in the assessment of disease activity and damage, discussing composite indices\ud and organ-specific scores; a separate section is dedicated to the imaging techniques\ud useful to assess neuropsychiatric, musculoskeletal and renal involvement. SLE-related\ud chronic damage and comorbid conditions contributing to patients’ illness and longterm\ud outcome are discussed. Finally, the impact of SLE on patients’ quality of life is\ud addressed focusing on self-reported questionnaires, adherence to treatment and\ud work ability

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Medication Nonadherence Is Associated With Increased Subsequent Acute Care Utilization Among Medicaid Beneficiaries With Systemic Lupus Erythematosus

Feldman

Yazdany

Guan

et al. 2015

Arthritis Care & Research

108

104

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Objective We examined whether nonadherence to hydroxychloroquine (HCQ) or immunosuppressive medications (IS) was associated with higher subsequent acute care utilization among Medicaid beneficiaries with systemic lupus erythematosus (SLE). Methods We utilized U.S. Medicaid data from 2000–2006 to identify adults 18–64 years with SLE who were new users of HCQ or IS. We defined the index date as receipt of HCQ or IS without use in the prior six months. We measured adherence using the medication possession ratio (MPR), the proportion of days covered by total days supply dispensed, for one-year post-index date. Our outcomes were all-cause and SLE-related emergency department (ED) visits and hospitalizations in the subsequent year. We used multivariable Poisson regression models to examine the association between nonadherence (MPR<80%) and acute care utilization adjusting for sociodemographics and comorbidities. Results We identified 9,600 HCQ new users and 3,829 IS new users with SLE. The mean MPR for HCQ was 47.8% (SD 30.3) and for IS, 42.7% (SD 30.7). 79% of HCQ users and 83% of IS users were nonadherent (MPR<80%). In multivariable models, among HCQ users, the incidence rate ratio (IRR) of ED visits was 1.55 (95% CI 1.43–1.69) and the IRR of hospitalizations was 1.37 (95% CI 1.25–1.50), comparing nonadherers to adherers. For IS users, the IRR of ED visits was 1.64 (95% CI 1.42–1.89) and of hospitalizations was 1.67 (95% CI 1.41–1.96) for nonadherers versus adherers. Conclusion In this cohort, nonadherence to HCQ and IS was common and was associated with significantly higher subsequent acute care utilization.

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Measuring therapeutic adherence in systemic lupus erythematosus with electronic monitoring

Abstract: Electronic monitoring demonstrated that only one-fourth of the patients had an adherence rate ≥80%. Polypharmacy and depression were associated with non-adherence.

Cited by 75 publications

References 28 publications

Adherence to Oral and Topical Medications in Cutaneous Lupus Erythematosus is not Well Characterized

Adherence to Oral and Topical Medications in Cutaneous Lupus Erythematosus is not Well Characterized

Developing new evaluation methods in systemic lupus erythematosus

Medication Nonadherence Is Associated With Increased Subsequent Acute Care Utilization Among Medicaid Beneficiaries With Systemic Lupus Erythematosus

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