EVALUATION OF ADHERENCE TO DRUG TREATMENT IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Abstract

Poor adherence to therapeutic regimens is a common and expensive problem in patients with chronic diseases including SLE and is associated with a higher risk of flares, morbidity, hospitalizations and poor renal outcome. Our aim was to measure the prevalence of adherence to drug treatment and analyze associations with medications prescribed, disease characteristics, health professionals performance and services, and socio-demographic issues in patients with SLE to improve patients’ outcome and quality of service. Our study was conducted on 100 patients with SLE (with disease duration of at least 1 year). All patients fulfilled the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria of SLE. All patients were recruited consecutively from the outpatient clinic and inpatient unit of Rheumatology Department at Ain Shams University Hospitals. All patients were subjected to detailed history taking and full clinical examination including musculoskeletal examination, ANA, Anti-dsDNA titers, urine analysis, CBC, ESR, assessment of disease activity by SLE disease activity index (SLEDAI) and assessment of disease damage using the SLICC/ACR damage Index. All patients completed the screening questionnaire of Shumba et al., 2013 which contained socio-demographic and clinical questions. The questionnaire also included an assessment of adherence to SLE medications (in the previous 6 months) using: (Number of doses taken)/(Number prescribed ) x 100% (Ward et al., 1999). We further classified our patients according to adherence rate into two groups: adherent and non adherent. The prevalence of adherence to drug treatment was 76%, while 24% of our patients were non-adherent (most of our patients in the study were governmentally insured). In our study, the cause of adherence in (44.74%) of adherent patients was their fear of disease worsening if medications were stopped. Feeling of moral obligation and responsibility to others (family members and health care workers) was the cause of adherence in (28.95%), while (26.32%) of the patients reported the previous two causes in combination. Forgetfulness was the reason for non adherence in our patients as a single cause (12.5%) or combined with other causes (66.66%), followed by high medications cost and difficulty to obtain medications (54%) in combination with other causes, then the large number of tablets prescribed (50%) in combination with other causes. (8.3%) of our non-adherent patients stopped taking their drugs when they felt better. Source of getting medications was high statistically significant factor in adherence (P<0.001) as 86.83% of the adherent patients were taking their medications at governmental expense. Also we found that there was statistically significant difference between both groups as regards affording the medications cost (P=0.041) as 89.47% of non-adherent patients couldn’t afford the cost. There was statistically significant difference between both groups as regards disease duration (P=0.032) as in non adherent, the median of disease duration was 7.71years which is higher than that of adherent group (5.7 years). There was statistically significant difference between both groups as regards development of side effects(especially gastritis and peptic ulcer) upon taking medications (P =0.047) as 91.60% of non-adherent patients developed side effects that made them stopped their drugs or reduce the dose. As regards disease activity, there was high statistically significant difference between both groups as regards SLEDAI score (P<0.001) as in non adherent, the median of SLEDAI score was 36.92 which is higher than that of adherent patients. Also we found high statistically significant difference between both groups as regards DI score (P<0.001) as in non adherent, the median of DI score was 6.67 which is higher than that of adherent patients.