Background/Purpose: It has been reported that 50% to 75% of patients with SLE do not adhere to their medications. However, the reasons for nonadherence are not clear. We aimed to estimate the level of medication adherence and barriers to adherence among patients attending the Lupus Clinic.

Methods: Patients taking at least one medication to treat SLE including antimalarials, immunosuppressives, or steroids were included. All patients satisfied the ACR classification criteria for SLE. Adherence was measured using the Medication Adherence Self-Report Inventory (MASRI). Patients were defined as nonadherent with adherence rates < 80% or sufficiently adherent with adherence rates ≥ 80%, based on the MASRI visual analog scale (VAS). Pill counts were conducted in a proportion of participants. Barriers to medication adherence were identified using the Identification of Medication Adherence Barriers Questionnaire (IMAB-Q).

Descriptive statistics were used.

Results: A total of 94 patients were recruited to the study and 28 pill counts were conducted. Ten patients were classified as nonadherent and 84 patients as sufficiently adherent. There were no statistically significant differences between groups in terms of demographics. The mean age of participants was 46.6 years, female: male ratio was approximately 9:1, mean disease duration was 18.0 years, mean SLEDAI score was 3.1, and mean SLICC score was 1.6. Forty-five percent of patients were taking steroid, 77.7% antimalarial, and 55.3% immunosuppressive medications. Eighty-eight percent of patients were taking at least one medication for non-SLE conditions (Table 1).

The mean medication adherence rate for the SLE patients was 90.7%, based on the MASRI VAS. Adherence rates were corroborated by pill counts. Important barriers to medication adherence reported by nonadherent patients were: concern about harmful medication side effects (50%), being easily distracted from taking medications as prescribed (50%), life getting in the way of taking medications as prescribed (50%), being unsure or disagreeing that their condition will worsen without taking medications as prescribed (50%), and having personal reasons for not taking medications as prescribed (50%). Patients defined as nonadherent reported significantly more barriers to medication adherence than patients defined as sufficiently adherent, based on IMAB-Q total scores (p < 0.001). Specific barriers to medication adherence that were experienced by nonadherent participants significantly more often (p < 0.001), included: being easily distracted from taking medications as prescribed, remembering to take medications as prescribed, having system(s) in place to help manage medications, taking medications as prescribed not fitting in their daily routine, not prioritizing or having the intention to take medications as prescribed, and having personal reasons for not taking medications as prescribed (Table 2).

Conclusion: The adherence rate in our population was higher than expected, reaching 90% on the MASRI, confirmed by pill count. A number of barriers to medication adherence were identified. These barriers to medication adherence need to be addressed on an individualized basis to improve patient outcomes.

Table 1. Patient and Disease Characteristics

Table 2. Barriers to Adherence

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/barriers-to-medication-adherence-and-degree-of-nonadherence-in-a-systemic-lupus-erythematosus-outpatient-population/