Adherence to hydroxychloroquine in patients with systemic lupus: Contrasting results and weak correlation between assessment tools - 28/11/20
, Noémie Le Gouellec b, David Launay a, Marie-Hélène Balquet c, Hélène Maillard a, Raymond Azar d, Amal Boldron e, Pierre Bataille f, Marc Lambert a, Anne-Laure Buchdahl g, Delphine Allorge h, Pierre-Yves Hatron a, Vincent Sobanski a, Benjamin Hennart h, Pierre Clerson i, Sandrine Morell-Dubois athe ESSTIM Investigators group
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Highlights |
• | The adherence rate to HCQ treatment in SLE varied between 3.2% and 32.5%. |
• | Correlations between blood HCQ-concentration and self-questionnaires are weak and agreement between methods was poor. |
• | Combining blood HCQ concentration with MASRI and MMAS-8 may help to better identify non-adherence in SLE. |
Abstract |
Objectives |
Hydroxychloroquine (HCQ) is an anchor drug in the treatment of systemic lupus erythematosus (SLE). Adherence to HCQ is key for efficacy. Inaccurate evaluation of adherence could lead to non-justified switch to more expensive or less tolerated drugs.
Methods |
Severe non-adherence rate to HCQ was estimated in a sample of SLE patients during a routine visit using blood HCQ concentration<200μg/L. Adherence was assessesd by the Medication Adherence Self-Report Inventory (MASRI)<80/100, 8-item Morisky Medication Adherence Scale (MMAS-8) ≤6/8, Health Care Provider (HCP) visual analog scale (VAS)<80/100. Same procedures were to be repeated during a further routine visit 6 to 12 months later. We described agreement and correlations between tools and compared severely non-adherent patients and others on their characteristics.
Results |
The study involved 158 patients (86.1% females) aged 42.2±12.6 years treated with HCQ for 9.6±6.9 years. Blood HCQ concentration (mean±standard deviation) was 1046±662μg/L at visit 1 and 855±577μg/L at visit 2. At visit 1, the non-adherence rate varied from 3.2% (blood HCQ level<200μg/L) to 7.7% (MASRI), 12.4% (HCP-VAS) or 32.5% (MMAS-8). 37.8% of patients met at least one of the definitions of non-adherence. Patients’ characteristics including SLE activity, damage and quality of life were similar between severely non-adherent patients and others. Correlations between blood HCQ-concentration and self-questionnaires were weak (r<0.25) and agreement between methods was poor.
Conclusion |
Blood HCQ concentration<200μg/L reveals severe non-adherence. Combining blood HCQ concentration with MASRI and MMAS-8 may help to better identify non-adherence in SLE. Agreement between methods was poor and correlations with HCQ level and SLE activity were weak.
Le texte complet de cet article est disponible en PDF.Keyword : Systemic Lupus Hydroxychloroquine Adherence
Plan
Vol 87 - N° 6
P. 603-610 - décembre 2020 Retour au numéro
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