Background/Purpose: Medication access and adherence play key roles in determining patient outcomes.  We investigated whether cost-related non-adherence (CRNA) to prescription medications was associated with worse patient-reported outcomes in a population-based SLE cohort.

Methods: This study utilized baseline data from the Michigan Lupus Epidemiology & Surveillance (MILES) Cohort. We collected detailed clinical, medication, and sociodemographic data through structured interviews and validated questionnaires. We used validated patient-reported outcome measures of SLE activity (Systemic Lupus Activity Questionnaire, SLAQ) and damage (Lupus Damage Index Questionnaire, LDIQ). CRNA was based on questions derived from the National Health Interview Survey and considered positive if participants reported any of the following actions to save money in the last 12 months: skipping doses, taking less medicine, and/or delaying filling prescriptions. We performed multivariable linear regression to examine the associations between CRNA and lupus activity and damage, adjusted for the following covariates: age, sex, race, health insurance type, education levels, household income below the US median, PROMIS-Depression, PROMIS-Anxiety, fulfillment of fibromyalgia survey criteria, and SLE duration.

Results: 462 SLE participants completed the study visit: 430 (93.1%) female, 208 (45%) black, and mean age 53.3 years. Of the 462 SLE cases, CRNA was reported by 100 (21.7%) for the preceding 12 months. Based on multivariable models, CRNA was associated with both higher levels of SLE activity and damage scores, after adjustment for covariates (Table 1): those reporting CRNA had SLAQ scores that were on average 2.7 points higher compared those not reporting deviation [β coeff 2.7 (95% CI 1.3, 4.1), p< 0.001] and LDIQ scores that were 1.4 points higher [β coeff 1.4 (95% CI 0.5, 2.4), p=0.003]. Non-white race, having Medicaid/Medicare (compared to private insurance), and fulfilling FM survey criteria were also associated with both higher SLAQ and LDIQ scores; female sex was further associated with higher SLAQ scores (Table 1).

Conclusion: SLE patients with CRNA in the last 12 months had higher disease activity and damage scores. Asking patients about financial barriers, using tools such as motivational interviewing to discuss medication adherence, and incorporating cost-related factors in shared decision making are likely meaningful avenues for improving patient outcomes.

Table 1

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cost-related-prescription-non-adherence-is-associated-with-patient-reported-outcomes-of-systemic-lupus-erythematosus-activity-and-damage-the-michigan-lupus-epidemiology-surveillance-miles-coh/