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The effectiveness of hydroxychloroquine (HCQ) is known to decrease with non-adherence (reported range, 3–85%) in patients with systemic lupus erythematosus (SLE). Here, we summarize the Systemic Lupus International Collaborating Clinics inception cohort study examining the association between severe non-adherence to HCQ and SLE flares, published by Nguyen et al.1 in Arthritis and Rheumatology.
In this international multicenter cohort study, serum of 660 patients receiving HCQ for at least 3 months was analyzed.
Figure 1. Multivariate analysis of factors associated with SLE flare and damage*
aHR, adjusted hazard ratio; aOR, adjusted odd ratio; CI, confidence interval; HCQ, hydroxychloroquine; SLE, systemic lupus erythematosus; SLEDAI-2K, SLE Disease Activity Index 2000 index; T0, time zero.
*Data from Nguyen, et al.1
This study demonstrates that non-compliance, measured by severe HCQ non-adherence, is associated with poor outcomes. This should prompt clinicians to better understand the causes of non-adherence and develop approaches to address them. In a previous study,2 we have demonstrated that non-compliance in at least 50% of patients is due to: concerns about harmful side effects, being easily distracted, life getting in the way, being unsure or disagreeing that their condition will worsen without medications, and personal reasons. Each of these patient concerns can be addressed through remedial approaches by physicians and other healthcare professionals treating patients with lupus.
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