Background 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.
Objectives To measure the prevalence of adherence to drug treatment and analyze its 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.
Methods 100 SLE patients (with disease duration ≥1year) fulfilled the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria recruited from the outpatient clinic and inpatient unit of Rheumatology & Internal Medicine Department at Ain Shams University Hospitals. After consent all patients subjected to detailed history taking and full clinical examination, ANA, Anti-dsDNA titers, urine analysis, CBC, ESR, assessment of disease activity by SLEDAI and assessment of disease damage using the SLICC/ACR damage Index. All patients completed the screening adherence survey questionnaire for assessment of adherence to SLE medications (in the previous 6 months).
Results The prevalence of adherence to drug treatment was 76%. The cause of adherence in 44.74% of adherent patients was their fear of disease worsening if medications were stopped, while feeling of moral obligation and responsibility to others (family members) was the cause of adherence in 28.95%. The reasons for non-adherence were forgetfulness (66.66%), high medications cost and difficulty to obtain medications (54%), then the large number of tablets prescribed (50%). 8.3% of our non-adherent patients stopped taking their drugs when they felt better. Source of getting medications was a highly statistically significant factor in adherence (P<0.001) as 86.83% of the adherent patients were taking their medications at governmental expense, while 89.47% of non-adherent patients couldn't afford. The non-adherent group had statistically significant higher disease duration (7.71 Vs 5.7 years) (P=0.032), higher prevalence of development of side effects (especially gastritis and peptic ulcer) (P=0.047) and higher SLEDAI (36.92 ±11.93 Vs 6.8±1.9) & DI score (6.67±2.5 Vs 0.21±0.47) (P<0.001) than the adherent group. 87.5% of non-adherent patients didn't regularly attend the clinic (P=0.068); the median of number of drugs was 5.33 which was higher than that of adherent group 4.6 (P=0.015). 61% of our patients were satisfied with the standards of care at the clinic (P<0.001).
Conclusions Longer disease duration, higher drug cost, forgetfulness and the large number of prescribed drugs are risk factors for SLE patients non adherence.
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Acknowledgement We like to thanks all the patients sharing with us in this study.
Disclosure of Interest None declared