The Prevalence and Causes of Non-adherence to Immunosuppressive Medications in Patients with Lupus Nephritis Flares

Ali, Ahmed Yamany; Abdelaziz, Tarek; Behiry, Mervat Essam

doi:10.2174/1573397115666190626111847

Cited by 16 publications

(13 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 22 This is probably one of the main drivers of poor kidney prognosis and ultimately of the high rates of death observed in our study since non-adherence is strongly associated with flaring of disease. 23 This should serve as a reminder to clinicians that much work needs to be done in properly educating and establishing trust between patients with LN and their medical team.…”

Section: Discussionmentioning

confidence: 99%

Kidney thrombotic microangiopathy in lupus nephritis: Impact on treatment and prognosis

Massicotte‐Azarniouch

Kotzen

Todd

et al. 2022

Lupus

View full text Add to dashboard Cite

Introduction Lupus nephritis (LN) may present with thrombotic microangiopathy (TMA) on kidney biopsy, the impact of which on outcomes is unclear. This study examined the prognostic importance of LN with TMA on kidney biopsy, including response to therapy and long-term outcomes. Methods We conducted a single-center, retrospective study of all cases of LN with concomitant TMA on kidney biopsy in the Glomerular Disease Collaborative Network database. Controls were individuals with LN without TMA matched to cases based on demographic and clinical variables. Outcomes were remission at 6- and 12-months, end-stage kidney disease (ESKD) and death. Logistic regression and Cox proportional hazards models were used to ascertain the risks for outcomes, with adjustment for serum creatinine and proteinuria. Results There were 17 cases and 28 controls. Cases had higher creatinine, higher proteinuria and greater chronicity on biopsy at baseline compared to controls. The rates of remission at 6-months and 12-months were similar between cases and controls (6-months 53.9% vs 46.4%, adjusted OR 2.54, 95% CI 0.48, 13.37; 12-months 53.9% vs 50.0%, adjusted OR 2.95, 95% CI 0.44, 19.78). Cases were at greater risk for ESKD in univariate analysis (HR 3.77; 95% CI 1.24, 11.41) but not when adjusting for serum creatinine and proteinuria (HR 2.20; 95% CI 0.63, 7.71). There was no significant difference in the risk of death between cases and controls. Conclusion Lupus nephritis with renal TMA likely responds to therapy similarly to those without TMA; risk for ESKD is not significantly increased, although the influence of renal function and proteinuria in larger samples is needed.

show abstract

Section: Discussionmentioning

confidence: 99%

Kidney thrombotic microangiopathy in lupus nephritis: Impact on treatment and prognosis

Massicotte‐Azarniouch

Kotzen

Todd

et al. 2022

Lupus

View full text Add to dashboard Cite

show abstract

“…Initially, it has been validated on 290 hypertensive patients showing an adequate reliability and internal consistency (Cronbach alpha = 0.61). It has been later used for the detection of nonadherence in other several health conditions in both Arabic-and non-Arabic speaking contexts [5][6][7][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”

Section: The Morisky Green and Levine (Mgl) Medication Adherence Scalementioning

confidence: 99%

“…While the other adherence scales developed by Prof. Morisky are copyrighted, the MGL scale is in the public domain and has been largely cited in the last decade in several research studies, including studies from the MENA region and Jordan [5][6][7][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”

Section: Introductionmentioning

confidence: 99%

Translation and validation of the Arabic version of the Morisky, Green and Levine (MGL) adherence scale

et al. 2022

View full text Add to dashboard Cite

The Morisky Green Levine (MGL) adherence scale is a 4-item tool used for the detection of medication nonadherence among patients with chronic health conditions. Despite being widely used in Arabic-speaking research contexts, it has never been validated in Arabic language. The aim of this study was to translate and validate the MGL tool into Arabic. A standard forward-backward process was used to translate the questionnaire. Cronbach’s alpha coefficient was measured to assess internal consistency of the scale. The test-retest reliability measured the consistency of participants’ responses over time. Construct validity was evaluated by Explanatory factor analysis (EFA); Kaiser-Meyer-Olkin value and Bartlett’s test of sphericity were determined. Convergent validity was assessed using a preexisting medications Arabic Adherence Assessment Tool (AAAT). The model fit was evaluated using confirmatory factor analysis (CFA). Associations between the MGL scale scores and the patient demographic/clinical characteristics were tested by linear regressions. A total of 201 participants were included into the study. The MGL scale categorization revealed that 20.9%, 59.2% and 19.9% of the participants had high, moderate and low levels of adherence respectively. Adequate internal consistency (alpha = 0.593) was observed. A significant strong ICC and Pearson’s correlations were generated between responses at time 1 and time 2. EFA results elucidated the suitability of the data for factor analysis. Pearson’s coefficient (r) revealed a significant strong correlation between MGL scale and AAAT. CFA results confirmed a good fit for the suggested model. Linear regression revealed higher number of medications, more frequent outpatient clinic visits and not experiencing medication adverse effect factors significantly associated with better adherence. The Arabic version of MLG scale is a reliable valid tool to assess adherence among Arabic-speaking communities. Implementing interventions targeting patients not compliant to regular clinic visits and those at higher risk of experiencing medication side effects can greatly enhance medication adherence.

show abstract

“…The CQR was used in four publications (18,22,27,41 not only in lupus, but also in systemic sclerosis and Behçet's disease, given it is specific for rheumatological disorders. The eight items of the MMAS were used in three papers (21,30,38), while the version with 4 items was used in two more papers (32,37). It is important to highlight that the 8-item MMAS was particularly valuable in these studies, as it makes it possible to recognize whether the causes of non-adherence are intentional or non-intentional, demonstrating the added value of this tool also regarding patient beliefs about medicine.…”

Section: Reviewmentioning

confidence: 99%

A systematic literature review of existing tools used to assess medication adherence in connective tissue diseases: the state of the art for the future development of co-designed measurement tools

et al. 2021

View full text Add to dashboard Cite

Lack of medication adherence is frequent in chronic connective tissue diseases and is associated with poorer health outcomes, low quality of life and economic loss. This research is based on a systematic literature search and aims to identify the surveys and tools used for the assessment of medication adherence in patients with connective tissue diseases (CTDs) and in particular the tools co-designed with patients. A systematic literature review was performed in PubMed and Embase databases searching for studies concerning the application of surveys or tools designed for medication adherence assessment. A specific analysis was also performed to identify which of these existing tools were developed in co-design with patients affected by CTDs. 1958 references were identified, and 31 studies were finally included. Systemic lupus erythematosus was the most investigated disease, followed by the Behçet’s disease. The tools used to assess adherence in CTDs were, in most cases, valid and useful. However, the results showed a certain degree of heterogeneity among the studies and the medication adherence assessment and measurement tools adopted, which were mostly based on selfreported questionnaire. No co-designed tools with patients were found. Low- and non-adherence were explored in some CTDs with valid and useful tools, while other CTDs still need to be assessed. Therefore, more efforts should be made to better understand the specific reasons for the low- and non-adherence in CTDs patients.

show abstract

The Prevalence and Causes of Non-adherence to Immunosuppressive Medications in Patients with Lupus Nephritis Flares

Cited by 16 publications

References 19 publications

Kidney thrombotic microangiopathy in lupus nephritis: Impact on treatment and prognosis

Kidney thrombotic microangiopathy in lupus nephritis: Impact on treatment and prognosis

Translation and validation of the Arabic version of the Morisky, Green and Levine (MGL) adherence scale

A systematic literature review of existing tools used to assess medication adherence in connective tissue diseases: the state of the art for the future development of co-designed measurement tools

Contact Info

Product

Resources

About