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Adherence to hydroxychloroquine in patients with systemic lupus: Contrasting results and weak correlation between assessment tools - 28/11/20

Doi : 10.1016/j.jbspin.2020.04.017 
Eric Hachulla a, , 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 a

the ESSTIM Investigators group

a Département de Médecine Interne et Immunologie Clinique, CHU Lille, Referral center for rare systemic autoimmune diseases North and Northwest of France, University Lille, Inserm U995 - LIRIC - Lille Inflammation Research International Center, 59000 Lille, France 
b Department of Internal Medicine and Nephrology, Valenciennes Hospital, Valenciennes, France 
c Department of Internal Medicine, Lens Hospital, Lens, France 
d Department of Nephrology, Dunkerque Hospital, Dunkerque, France 
e Department of Pneumology, Dunkerque Hospital, Dunkerque, France 
f Department of Internal Medicine and Nephrology, Boulogne Hospital, Boulogne, France 
g Department of Internal Medicine, Douai Hospital, Douai, France 
h Unité Fonctionnelle de Toxicologie, Lille Hospital, Lille, France 
i Soladis Clinical Studies, Roubaix, France 

Corresponding author at: Department of Internal Medicine and Clinical Immunology, Lille University, 59037 Lille, France.Department of Internal Medicine and Clinical Immunology, Lille UniversityLille59037France

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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.

El texto completo de este artículo está disponible en PDF.

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.

El texto completo de este artículo está disponible en PDF.

Keyword : Systemic Lupus Hydroxychloroquine Adherence


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© 2020  Société française de rhumatologie. Publicado por Elsevier Masson SAS. Todos los derechos reservados.
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Vol 87 - N° 6

P. 603-610 - décembre 2020 Regresar al número
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