Background : Treatment adherence is associated with better disease control, improved morbidity and mortality and increased quality of life.1 Studies examining treatment adherence predictors have varied in examined characteristics and results. This study analyzes demographic and socioeconomic factors, perceptions, and experiences influencing hydroxychloroquine (HCQ) treatment adherence among people with lupus. HCQ has long been used to treat lupus, and has been shown to reduce damage accrual and has protective effects on diseases such as diabetes and hyperlipidemia as well as overall survival in people with lupus.2
Methods : Cross-sectional study data was obtained through the 2015-2016 Lupus Needs Survey, an online national needs assessment among 3,022 adults self-reporting a lupus diagnosis. Univariate analyses were conducted using chi-square and simple logistic regressions among 21 variables, which were subsequently dichotomized. Variables with rates of missing values >15% of total sample were removed in further analysis. Next, 13 variables with a p-value <0.20 were entered into a binary logistic model using backwards stepwise selection.
Results : 2,028 individuals reported currently taking HCQ with 1,581 (78.0%) individuals reporting taking the medication exactly as prescribed all of the time, 385 (19.0%) reporting most of the time, and 62 (3.1%) reporting sometimes or never taking HCQ as prescribed. People with lupus were twice as likely to adhere to HCQ if they reported having a rheumatologist as the primary doctor treating their lupus (p=0.046, OR=2.00) and more than twice as likely if they reported having a positive impression of HCQ (p=0.029, OR=2.14) or experienced improvement in treating their symptoms using HCQ (p=0.009, OR=2.49). Notably, African Americans and those indicating race as Other (mixed, American Indian/Alaskan Native, Pacific Islander or Middle Eastern) were 65% less likely to adhere to HCQ treatment (p=0.002, OR=0.35; p=0.021, OR=0.35, respectively).
Conclusions : The study confirms the importance of experiential factors such as medication impression and patient-reported symptom improvement in HCQ treatment adherence. Additionally, results highlight the potential significance of having a specialist as the primary lupus doctor. This may be due to rheumatologists’ higher awareness of the value of HCQ for lupus patients compared to other providers. Further exploration is needed on cultural factors negatively influencing treatment adherence among certain racial groups, particularly African Americans and Other racial groups (mixed, American Indian/Alaskan Native, Pacific Islander or Middle Eastern). Treatment adherence is particularly important in lupus given the complex nature of the disease and fluctuation of disease activity, which may be exacerbated by poor adherence.