Nonadherence to Lupus Treatment Heightens Hospital Admissions

Many patients with systemic lupus erythematosus (SLE) don’t adhere to their medications, leading to significantly more emergency department (ED) visits and hospital admissions.

Relying on Medicaid data from 2000 to 2006, researchers identified SLE patients aged between 18 and 64 years who were new users of hydroxychloroquine (Plaquenil) or immunosuppressive agents.

Nonadherence to these medications was common in the cohort, as nearly 80% of the 9600 new hydroxychloroquine users and 83% of the 3829 new immunosuppressive users were considered noncompliant.

This medication nonadherence was, in turn, associated with greater all-cause and SLE-related ED visits and hospitalizations, the researchers determined.

Several factors can affect an SLE patient’s propensity to be noncompliant with treatment.

“Patients often think that their medication is just to treat their symptoms and don’t get the full picture that medications are needed to actually control the disease and prevent complications,” Elena Weinstein, MD, FACR, an assistant clinical professor at the University of Colorado School of Medicine, told Pharmacy Times. “If the provider[s] don’t convey this in clear, layperson terms, patients feel they can choose when to take their medication based on how they feel.”

Misinformation about potential SLE medication risks may also contribute to treatment nonadherence.

“Patients may hear from friends or read on the Internet that some of these medications are used for cancer, cause blindness, and suppress the immune system—and they imagine the worst,” Donald Miller, PharmD, a professor of pharmacy practice at North Dakota State University, told Pharmacy Times. “Sometimes, people may be told…that drugs are so toxic that they should try natural approaches like special anti-inflammatory diets or supplements instead of the prescribed medication.”

Health-system pharmacists can play a vital role in mitigating medication nonadherence among SLE patients.

“It is so important that pharmacists truly counsel patients about new medication, explain what to expect, and answer any questions,” Dr. Miller said.

Because lupus is a multisystem disease, Dr. Weinstein explained, “multidisciplinary care and communication among providers is essential to ensure that concomitant mood disorders and sleep issues are being adequately addressed.”

The study was published in Arthritis Care and Research.