Medication Nonadherence in Systemic Lupus Erythematosus: A Systematic Review.

OBJECTIVE: Medication nonadherence has not been well characterized in systemic lupus erythematosus (SLE). Our objective was to a conduct a systematic review of the literature, examining the burden and determinants of medication nonadherence in SLE. METHODS: We conducted a systematic search of Medline (1946-2015), Embase (1974-2015), and Web of Science (1900-2015) databases and selected original studies of SLE patients that evaluated nonadherence to SLE therapies as the primary study outcome. We extracted information on study design, sample size, length of followup, data sources, type of nonadherence problem examined, adherence measures and reported estimates, and determinants of adherence reported in multivariable analyses. RESULTS: After screening 4,111 titles, 11 studies met the inclusion criteria. Study sample sizes ranged from 32 to 246 patients, and studies were categorized according to data source: self-report (5), electronic monitoring devices (1), clinical records from rheumatology clinics (3), and refill information from pharmacy records (2). Overall, the percentage of nonadherent patients ranged from 43% to 75%, with studies consistently reporting that over half of patients are nonadherent. Studies also showed that up to 33% of patients discontinue therapy after 5 years. Determinants of nonadherence included having depression, rural residence, lower education level, and polypharmacy. CONCLUSION: Overall, synthesis of current evidence suggests that the burden of medication nonadherence is substantial in SLE. Findings highlight the importance of developing interventions to support adherence and improve outcomes among patients.

What are the effects of medication adherence interventions in rheumatic diseases: a systematic review.

OBJECTIVES: Consistent reports of suboptimal treatment adherence among patients with inflammatory arthritis underscore the importance of understanding how adherence can be promoted and supported. Our objectives were to identify and classify adherence interventions; and assess the evidence on the effects of adherence interventions on outcomes of patients with rheumatic diseases. METHODS: We conducted a mapped search of Medline, Embase and International Pharmaceutical Abstract databases to identify studies meeting inclusion criteria of: (1) patient population with inflammatory arthritis; (2) evaluation of an intervention or programme targeting medication adherence directly or indirectly; (3) reporting of one or more measures of medication adherence and disease outcome; (4) publication in English, French or Spanish. For our first objective, we applied a structured framework to classify interventions according target (patient vs provider), focus (educational vs behavioural vs affective), implementation (generalised vs tailored), complexity (single vs multifaceted) and provider. For the second objective, we appraised the evidence of effects of interventions on adherence and disease outcomes. RESULTS: We identified 23 studies reporting adherence interventions that directly or indirectly addressed treatment adherence in rheumatic diseases and further appraised included RCTs. Interventions that were shown to impact adherence outcomes were generally interventions directed at adherence, tailored to patients and delivered by a healthcare provider. For interventions that were not shown to have impacts, reasons may be those related to the intervention itself, patient characteristics or study methodology. CONCLUSIONS: Our systematic review shows limited research on adherence interventions in rheumatic diseases with inconsistent impacts on adherence or disease outcome.