SLE: Poor Medication Adherence

Dr. Jinoos Yazdany MD, MPH Assistant Professor in Residence UCSF School of Interview with:
Dr. Jinoos Yazdany MD, MPH
Assistant Professor in Residence
UCSF School of Medicine What are the main findings of the study?

Answer: For almost all of the drugs we examined, we found that less than half of patients adhered to treatment.  For some drugs, less than one-third of individuals were adherent. The average medication possession ratios were low across all drugs.

We found that several factors played an important part in adherence.  Younger individuals were less likely to adhere to treatment for several drugs, and we also found racial/ethnic differences, with Black, Hispanic and Native populations having lower adherence.  We also found geographic variation in adherence, with individuals in the Northeast being the most likely to adhere to treatment. Were any of the findings unexpected?

Answer: As a physician who spends my professional time taking care of people with lupus, these data are highly concerning.  For many individuals with lupus, treatment is very effective and has a proven track record of preventing life-threatening complications and long-term organ damage such as kidney failure.  The fact that less than one in three patients are adhering with treatment is surprising and lower than expected. What should clinicians and patients take away from your report?

Answer: Physicians may be unaware of their patient’s adherence with medication, and patients’ may not be forthcoming about this issue.  Concerns about side effects, inadequate understanding of the benefit and cost may be barriers for patients.  Treatment associated side effects may be another important barrier.  There is clearly a need for better patient-physician communication around the issue of adherence.  And we urgently need interventions that assess and improve adherence. What recommendations do you have for future research as a result of this study? 

Answer: Moving forward, we need studies that will help us improve adherence in lupus.  One exciting study that was just funded by the Patient-Centered Research Outcomes Institute (PCORI) that we are conducting with investigators at the University of Alabama, will develop and test a treatment decision aid for minority patients with lupus nephritis that incorporates their specific concerns as well as perceived barriers to treatment.  More studies such as this are needed if we are to begin to address the underlying reasons for poor adherence in individuals with lupus.


Poor Adherence To Medications For Systemic Lupus Erythematosus Among U.S. Medicaid Beneficiaries

Abstract: #1588 Presenter: Yazdany, Jinoos MD, MPH

Co-Authors: Liu, Jun PhD; Alarcon, Graciela S. MD, MPH; Costenbader, Karen H. MD, MPH; Feldman, Candace H. MD, MPH