Note of Republication: A Prospective International Study on Adherence to Treatment in 305 Patients With Flaring SLE: Assessment by Drug Levels and Self‐Administered Questionnaires

Abstract

Nonadherence to treatment is a major cause of lupus flares. Hydroxychloroquine (HCQ), a major medication in systemic lupus erythematosus, has a long half-life and can be quantified by high-performance liquid chromatography. This international study evaluated nonadherence in 305 lupus patients with flares using drug levels (HCQ <200 ng/ml or undetectable desethylchloroquine), and self-administered questionnaires (MASRI <80% or MMAS-8 <6). Drug levels defined 18.4% of the patients as severely nonadherent. In multivariate analyses, younger age, nonuse of steroids, higher body mass index, and unemployment were associated with nonadherence by drug level. Questionnaires classified 39.9% of patients as nonadherent. Correlations between adherence measured by questionnaires, drug level, and physician assessment were moderate. Both methods probably measured two different patterns of nonadherence: self-administered questionnaires mostly captured relatively infrequently missed tablets, while drug levels identified severe nonadherence (i.e., interruption or erratic tablet intake). The frequency with which physicians miss nonadherence, together with underreporting by patients, suggests that therapeutic drug monitoring is useful in this setting. (Trial registration: ClinicalTrials.gov: NCT01509989.).

Renal transplantation for lupus nephritis: non-adherence and graft survival

“…Therefore, if the patients do not renew their prescriptions in the community, the General Practitioner or the pharmacist will quickly become aware of this and will bring this to the attention of the clinical team for further evaluation. A recent article revealed that although patient reporting could detect even relatively infrequently missed tablets, drug monitoring could also identify severe nonadherence 3 . Thus, we also reviewed the trough blood levels recorded for patients on tacrolimus or ciclosporin and mycophenalate mofetil (MMF) to help ascertain evidence of non-adherence.…”

“…According to the World Health Organization medication adherence is "the extent to which a person's behaviour (taking medications, following a recommended diet and/or executing life-style changes) corresponds with the agreed recommendations of a health care provider 1 ." We and others have shown that adherence to medication is variable in patients with systemic lupus erythematosus (SLE), with poor adherence often affecting more than 50% of the patients; this might potentially be associated with worse overall prognosis [2][3][4] .…”

The Main Challenges in Systemic Lupus Erythematosus: Where Do We Stand?

“…Therefore, we should conduct more and better designed trials to evaluate psycho-behavioral interventions as well as pharmacological interventions for the management of fatigue in SLE, targeting depression and anxiety. In SLE, just as in any other chronic disease, the proportion of patients not adhering fully to the prescribed treatments is very high [ 76 ] and can lead to apparently refractory disease [ 77 ]. The main predictors of non-adherence are a younger age, non-white ethnic background, low social-economic level, lower education level, unemployment, never-use of GCs, polymedication, mood disorders such as depression and rural residency [ 76 , 78 ].…”

“…In SLE, just as in any other chronic disease, the proportion of patients not adhering fully to the prescribed treatments is very high [ 76 ] and can lead to apparently refractory disease [ 77 ]. The main predictors of non-adherence are a younger age, non-white ethnic background, low social-economic level, lower education level, unemployment, never-use of GCs, polymedication, mood disorders such as depression and rural residency [ 76 , 78 ]. Non-adherence contributes to worse patient outcomes, including an increased number of flares, visits to emergency departments and, importantly, mortality [ 76 ].…”

“…The main predictors of non-adherence are a younger age, non-white ethnic background, low social-economic level, lower education level, unemployment, never-use of GCs, polymedication, mood disorders such as depression and rural residency [ 76 , 78 ]. Non-adherence contributes to worse patient outcomes, including an increased number of flares, visits to emergency departments and, importantly, mortality [ 76 ]. Also, disease prevalence, activity and severity is strongly increased in SLE smokers compared to non-smokers [ 79 ], while therapeutic responses are decreased [ 80 ].…”