Background/Purpose: Medication adherence poses a challenge for patients with SLE, especially younger patients, who often experience both more active disease and more intensive treatments than their older counterparts. Risk factors associated with nonadherence in patients with SLE have been described; however, modifiable adherence barriers specific to young adults under 30 years old remain poorly understood. Thus, this study compared medication nonadherence and drivers of nonadherence by age group.

Methods: Participants in this study were enrolled in an academic SLE Registry at a large academic medical center in the United States. From February 2020 to June 2024, we prospectively collected responses to the DOSE-Nonadherence-SLE questionnaire, a clinical tool validated to measure both the extent of and the reasons for medication nonadherence in SLE. The questionnaire organizes reasons for nonadherence into Capability, Opportunity, and Motivation categories. We defined nonadherence as binary: Patients were considered nonadherent if they reported missing or skipping at least one dose of lupus medication over the past seven days in the extent of nonadherence domain. We calculated proportions and odds ratios for extent of nonadherence by decade of life and for reasons for nonadherence across age groups < 30 and ≥30 years old. We also used logistic regression to determine relationships of nonadherence with age and other covariates.

Results: Of the 336 completed unique DOSE-Nonadherence-SLE questionnaires, 55 (16%) were from patients < 30 years old (Table 1). Medication nonadherence differed significantly across age groups 18-30, 30-40, 40-50, and 50+ (p< 0.01); for each increased year of age, self-reported nonadherence decreased by 2% (p< 0.05). Black race and Hispanic ethnicity were also predictive of nonadherence (Table 2). Across age groups, the most common reasons for nonadherence were “I forgot or I was busy” (69%), “I do not have a regular schedule (28%), and “I am tired of taking medicines every day” (27%). Patients < 30 were more likely to report nonadherence due to inability to fill a medication on time (41% vs. 16%, OR 3.72; 95% CI: 1.53, 9.02) and due to needing to take a medicine with food but not being able to eat (38% vs. 19%, OR 2.55; 95% CI: 1.06, 6.13) (Figure 1).

Conclusion: Younger patients reported greater extent of medication nonadherence, often due to logistical impediments. In addition to counseling on the importance of medication adherence, rheumatologists should, when possible, provide support to help young adults with SLE overcome challenges in obtaining and taking medicines. Approaches to understanding and intervening on medication nonadherence in SLE may need to be tailored by age.

Figure 1. Reasons for nonadherence per DOSE-nonadherence-SLE self-reports for patients < 30 vs. patients 30 years old and over.

Reasons for nonadherence are organized by reason category (Capability, Opportunity, or Motivation) and listed in descending order by odds ratios within each category. *denotes p < 0.05, **denotes p < 0.005

Table 1. Cohort demographics and characteristics.

Values presented as n (%) unless otherwise indicated.

Table 2. Results of logistic regression for extent of nonadherence.

Significant odds ratios are bolded. *Multivariable analysis includes only those variables with p-value < 0.05 in the univariate models.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/differences-in-self-reported-medication-nonadherence-and-its-drivers-in-young-adults-versus-older-adults-with-systemic-lupus-erythematosus/