Forgetfulness a strong barrier to treatment adherence in lupus, vasculitis patients

Tristan Manalac
24 Jun 2018

While self-reported adherence to treatment appears to be high for both systemic lupus erythematosus and vasculitis, patient forgetfulness remains a strong barrier, according to a research presented at the 2018 Annual European Congress of Rheumatology (EULAR 2018).

The survey included 199 patients, of whom 55 percent (n=110) had systemic lupus erythematosus while 38 percent (n=75) had vasculitis. The remaining 7 percent (n=14) had other conditions and were thus excluded from the analysis. [EULAR 2018, abstract AB1242]

Treatment adherence was better in vasculitis patients, significantly more of whom reported attending at least 75 percent of their clinic appointments relative to patients with SLE (100 percent vs 93 percent; p=0.022). The same was true for being able to manage taking their medications correctly (96 percent vs 51 percent; p=0.0001).

Self-report of always taking medications as prescribed by their doctors were nonsignificantly more frequent in vasculitis vs lupus patients (81 percent vs 67 percent; p=0.104). A 7 out of 10 self-rating of disease activity was likewise marginally higher in vasculitis patients (23 percent vs 16 percent; p=0.324).

In contrast, while lupus patients were significantly more likely to self-report disease durations of >10 years (58 percent vs 24 percent; p<0.001), they were also more likely to decrease adherence to medication over time (p=0.011).

Both groups reported statistically comparable high rates of self-medication (vasculitis: 96 percent; lupus: 95 percent; p=1.00). Patients took an average of five different tablets each.

In both groups, the most common cause of failure to adhere to medication and hospital appointments was nondeliberate forgetfulness. Concerns about side effects – such as weight gain, osteoporosis, changes in appearance, fatigue and nausea – were also barriers to better treatment adherence.

A small percentage of participants (<5 percent) identified religious reasons and alternative therapies as a reason for nonadherence.

In the present study, researchers employed an anonymized survey using self-report questionnaires to determine emerging behaviours, differences and patterns in treatment adherence between lupus and vasculitis patients. Questionnaires were designed to also collect information about factors that potentially influenced adherence.

Participants were recruited from the University College Hospital and Royal Free Hospital, both of which serve urban and ethnically diverse populations.

The findings suggest that “novel behavioural or electronic cues for medication, including mobile app use, and appointment alerts could lead to improvement,” said researchers.

“Further work is required to identify whether a different personalized approach in the lupus and vasculitis patients can improve adherence,” they added.

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