SLE Patients With Poor Medication Compliance More Likely to Need Acute Care Services

A newly published study, titled, “Medication nonadherence is associated with increased subsequent acute care utilization among medicaid beneficiaries with systemic lupus erythematosus” in the journal Arthritis Care & Research, suggests SLE patients with poor medication compliance were more likely to experience emergency room visits and hospitalizations compared to those with better medication compliance. Dr. Candace Feldman, Associate Physician at Brigham and Women’s Hospital and the Lupus Foundation of America’s first-ever Career Development Award recipient, led the investigation, which involved almost 10,000 lupus patients covered by Medicaid.

One of the main observations Dr. Feldman’s research team made in previous studies is that Medicaid beneficiaries had a high prevalence of lupus, and may have a higher risk of poor disease outcomes. This study’s goal was to identify factors that could be placing these patients at risk, and hopefully arrive at interventions to improve disease outcomes.

The investigators found that Medicaid beneficiaries with lupus had very poor adherence to hydroxychloroquine (Plaquenil) and to immunosuppressive medications. An increased frequency of lupus-related emergency department visits and hospital admissions were also noted in these individuals. While the study’s design does not conclusively pinpoint poor medication adherence to increased need for acute care services, Dr. Feldman noted that even with adjustments for comorbidities and demographic factors, these patients still exhibited increased needs for acute care services compared to those with better compliance. The team also observed that the patients with poor adherence tended to be younger, less sick, and were prescribed fewer medications.

When asked about the study’s limitations, Dr. Feldman commented, “The main limitation of this study was that we used administrative claims data for our analyses which lack clinical information regarding lupus disease activity or duration. In addition, we were unable to determine reasons for non-adherence, such as whether medications were stopped because of side effects or ineffectiveness. We also measured adherence using billing claims for prescription refills. Adherence is a complex behavior and refilling a medication does not guarantee that individuals are taking the medication as prescribed.”

The second most common event experienced by patients with newly onset systemic lupus erythematosus (SLE) was found to be mood disorders, with roughly one third of the occurrences related to the disease. These are the conclusions of a recent study led by John Hanly and presented during the European League Against Rheumatism Annual European Congress of Rheumatology (EULAR 2015), Rome.