P110 Adherence with mycophenolate mofetil in connective tissue disorders

Abstract

Background/Aims Connective tissue disorders like systemic lupus erythematosus (SLE) are multi-organ systemic conditions characterised by disordered immune function. Mycophenolate mofetil (MMF) is commonly used for treatment of SLE and other connective tissue disorders. Compliance with drugs remains a significant issue in management of these conditions and varying reports from across the world continue to show significant lack of concordance resulting in increased disease activity and damage. The aim of this study was to investigate the adherence specifically with MMF treatment among patients attending clinics at University Hospitals Coventry and Warwickshire NHS Trust (UHCW)with SLE and other connective tissue disorders. Methods Ethical approval was obtained through research and development department within the Trust. This is a retrospective study collating non-identifiable hospital pharmacy data in patients who requested the prescription for MMF drug between January 2015 and December 2018. Clinical data were obtained from paper and electronic notes. Data were analysed using Microsoft Excel. Results We recruited 144 patients into this study with a wide age range from 18 to 91 years. Demographic data showed 100 out of 144 cases were females and 44 were males. There were 112 Caucasian patients, 22 of South Asian origin, 3 East Asian and 4 black patients. Of the 144 patients, SLE was the diagnosis for 56 patients and 88 patients had other diagnoses including scleroderma (18), mixed connective tissue disease (15), myositis (13), vasculitis (13) and Sjogren’s syndrome (10). Overall adherence with MMF was 68.3%. We found good adherence was seen in age group 41-60 years, tailing off in younger and older adults. The adherence rates were below 80% for all the age groups. Poor adherence with MMF correlated with 50% increase in risk of flares, with good adherence reducing the risk by 50% compared with overall risk of flares. We found a significant correlation between lack of compliance and risk of flares (r = 0.25, p < 0.002). We compared the results for 112 Caucasian patients and 25 Asian patients which included South Asian and South East Asian patients. This showed a significant difference with reduced adherence among Asian patients (mean adherence 48%) in comparison to Caucasian patients (mean adherence 65%, p = 0.0055). There were no differences between SLE and other CTDs. We also did not find any trends with organ involvement, specifically with neurological involvement. Conclusion Adherence with MMF has improved considerably compared to previous studies. However, challenges remain and certain population groups such as young adults, elderly and Asian patients continue to have low adherence levels. Alternative strategies are needed to improve their health and reduce risk of flares and organ damage. Disclosure A. Chauhan: None. H. Bunting: None. S. Dubey: Honoraria; Lilly, Abbvie. Member of speakers’ bureau; Janssen.

Association of patient copayment and medication adherence in systemic lupus erythematosus

“…A previous Medicaid claims data study reported adherence to azathioprine and mycophenolate mofetil to be as low as <22%, 36 while a small retrospective study of connective tissue diseases (SLE, mixed connective tissue disease, myositis, vasculitis and Sjogren's syndrome were included) found an overall adherence to mycophenolate mofetil of 68.3%. 37 Interestingly, in our study, azathioprine had the largest Epidemiology and outcomes magnitude of decrease in odds of adherence for high copayments (56%), and mycophenolate mofetil had the highest absolute copayment (median of $10), as shown in table 2.…”