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Note of Republication: A Prospective International Study on Adherence to Treatment in 305 Patients With Flaring SLE: Assessment by Drug Levels and Self‐Administered Questionnaires
Author(s) -
Nathalie Costédoat-Chalumeau,
Frédéric Houssiau,
Peter Izmirly,
Véronique Le Guern,
Sandra V. Navarra,
Meenakshi Jolly,
Guillermo RuizIrastorza,
Gabriel Baron,
Éric Hachulla,
Nancy AgmonLevin,
Yehuda Shoenfeld,
Francesca Dall’Ara,
Jill P. Buyon,
C. Deligny,
Ricard Cervera,
Estibaliz Lazaro,
H. Bézanahary,
Gaëlle Leroux,
Nathalie Morel,
J.F. Viallard,
Christian Pineau,
Lionel Galicier,
Ronald van Vollenhoven,
Anǵela Tincani,
Hanh Nguyen,
G. Gondran,
Noël Zahr,
J. Pouchot,
Jean Charles Piette,
Michelle Petri,
David Isenberg
Publication year - 2018
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1002/cpt.885
Subject(s) - medicine , hydroxychloroquine , drug , systemic lupus erythematosus , drug class , multivariate analysis , prospective cohort study , pharmacology , covid-19 , disease , infectious disease (medical specialty)
Nonadherence to treatment is a major cause of lupus flares. Hydroxychloroquine (HCQ), a major medication in systemic lupus erythematosus, has a long half-life and can be quantified by high-performance liquid chromatography. This international study evaluated nonadherence in 305 lupus patients with flares using drug levels (HCQ <200 ng/ml or undetectable desethylchloroquine), and self-administered questionnaires (MASRI <80% or MMAS-8 <6). Drug levels defined 18.4% of the patients as severely nonadherent. In multivariate analyses, younger age, nonuse of steroids, higher body mass index, and unemployment were associated with nonadherence by drug level. Questionnaires classified 39.9% of patients as nonadherent. Correlations between adherence measured by questionnaires, drug level, and physician assessment were moderate. Both methods probably measured two different patterns of nonadherence: self-administered questionnaires mostly captured relatively infrequently missed tablets, while drug levels identified severe nonadherence (i.e., interruption or erratic tablet intake). The frequency with which physicians miss nonadherence, together with underreporting by patients, suggests that therapeutic drug monitoring is useful in this setting. (Trial registration: ClinicalTrials.gov: NCT01509989.).