A Prospective International Study on Adherence to Treatment in 305 Patients With Flaring SLE: Assessment by Drug Levels and Self‐Administered Questionnaires
Nonadherence to treatment is a major cause of lupus flares. Hydroxychloroquine (HCQ), a major medication in systemic lupus erythematosus, has a long half‐life and can be quantified by high‐performance liquid chromatography. This international study evaluated nonadherence in 305 lupus patients with f...
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| Veröffentlicht in: | Clinical pharmacology and therapeutics 2019-08, Vol.106 (2), p.374-382 |
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| creator | Costedoat‐Chalumeau, Nathalie Houssiau, Frédéric Izmirly, Peter Guern, Véronique Le Navarra, Sandra Jolly, Meenakshi Ruiz‐Irastorza, Guillermo Baron, Gabriel Hachulla, Eric Agmon‐Levin, Nancy Shoenfeld, Yehuda Dall'Ara, Francesca Buyon, Jill Deligny, Christophe Cervera, Ricard Lazaro, Estibaliz Bezanahary, Holy Leroux, Gaëlle Morel, Nathalie Viallard, Jean‐François Pineau, Christian Galicier, Lionel Vollenhoven, Ronald Van Tincani, Angela Nguyen, Hanh Gondran, Guillaume Zahr, Noel Pouchot, Jacques Piette, Jean‐Charles Petri, Michelle Isenberg, David |
| description | Nonadherence to treatment is a major cause of lupus flares. Hydroxychloroquine (HCQ), a major medication in systemic lupus erythematosus, has a long half‐life and can be quantified by high‐performance liquid chromatography. This international study evaluated nonadherence in 305 lupus patients with flares using drug levels (HCQ |
| doi_str_mv | 10.1002/cpt.1194 |
| format | Article |
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Hydroxychloroquine (HCQ), a major medication in systemic lupus erythematosus, has a long half‐life and can be quantified by high‐performance liquid chromatography. This international study evaluated nonadherence in 305 lupus patients with flares using drug levels (HCQ < 200 ng/ml or undetectable desethylchloroquine), and self‐administered questionnaires (MASRI < 80%). Drug levels defined 18.4% of the patients as severely nonadherent. In multivariate analyses, younger age, nonuse of steroids, higher body mass index, and unemployment were associated with nonadherence by drug level. Questionnaires classified 23.4% of patients as nonadherent. Correlations between adherence measured by questionnaires, drug level, and physician assessment were moderate. Both methods probably measured two different patterns of nonadherence: self‐administered questionnaires mostly captured relatively infrequently missed tablets, while drug levels identified severe nonadherence (i.e., interruption or erratic tablet intake). The frequency with which physicians miss nonadherence, together with underreporting by patients, suggests that therapeutic drug monitoring is useful in this setting. 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Hydroxychloroquine (HCQ), a major medication in systemic lupus erythematosus, has a long half‐life and can be quantified by high‐performance liquid chromatography. This international study evaluated nonadherence in 305 lupus patients with flares using drug levels (HCQ < 200 ng/ml or undetectable desethylchloroquine), and self‐administered questionnaires (MASRI < 80%). Drug levels defined 18.4% of the patients as severely nonadherent. In multivariate analyses, younger age, nonuse of steroids, higher body mass index, and unemployment were associated with nonadherence by drug level. Questionnaires classified 23.4% of patients as nonadherent. Correlations between adherence measured by questionnaires, drug level, and physician assessment were moderate. Both methods probably measured two different patterns of nonadherence: self‐administered questionnaires mostly captured relatively infrequently missed tablets, while drug levels identified severe nonadherence (i.e., interruption or erratic tablet intake). The frequency with which physicians miss nonadherence, together with underreporting by patients, suggests that therapeutic drug monitoring is useful in this setting. 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Hydroxychloroquine (HCQ), a major medication in systemic lupus erythematosus, has a long half‐life and can be quantified by high‐performance liquid chromatography. This international study evaluated nonadherence in 305 lupus patients with flares using drug levels (HCQ < 200 ng/ml or undetectable desethylchloroquine), and self‐administered questionnaires (MASRI < 80%). Drug levels defined 18.4% of the patients as severely nonadherent. In multivariate analyses, younger age, nonuse of steroids, higher body mass index, and unemployment were associated with nonadherence by drug level. Questionnaires classified 23.4% of patients as nonadherent. Correlations between adherence measured by questionnaires, drug level, and physician assessment were moderate. Both methods probably measured two different patterns of nonadherence: self‐administered questionnaires mostly captured relatively infrequently missed tablets, while drug levels identified severe nonadherence (i.e., interruption or erratic tablet intake). The frequency with which physicians miss nonadherence, together with underreporting by patients, suggests that therapeutic drug monitoring is useful in this setting. (Trial registration: ClinicalTrials.gov: NCT01509989.)</abstract><cop>United States</cop><pub>American Society for Clinical Pharmacology and Therapeutics</pub><pmid>30079582</pmid><doi>10.1002/cpt.1194</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-7432-847X</orcidid><orcidid>https://orcid.org/0000-0002-3223-2071</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinical pharmacology and therapeutics, 2019-08, Vol.106 (2), p.374-382 |
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| language | eng |
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| source | Wiley Online Library Journals Frontfile Complete; SWEPUB Freely available online |
| subjects | Life Sciences |
| title | A Prospective International Study on Adherence to Treatment in 305 Patients With Flaring SLE: Assessment by Drug Levels and Self‐Administered Questionnaires |
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