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Publication Detail
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
  • Publication Type:
    Journal article
  • Publication Sub Type:
    Article
  • Authors:
    Costedoat-Chalumeau N, Houssiau F, Izmirly P, Le Guern V, Navarra S, Jolly M, Ruiz-Irastorza G, Baron G, Hachulla E, Agmon-Levin N, Shoenfeld Y, Dall'Ara F, Buyon J, Deligny C, Cervera R, Lazaro E, Bezanahary H, Leroux G, Morel N, Viallard J-F, Pineau C, Galicier L, Van Vollenhoven R, Tincani A, Nguyen H, Gondran G, Zahr N, Pouchot J, Piette J-C, Petri M, Isenberg D
  • Publisher:
    Nature Publishing Group
  • Publication date:
    01/06/2018
  • Journal:
    Clinical Pharmacology and Therapeutics
  • Medium:
    Print-Electronic
  • Print ISSN:
    0009-9236
  • Language:
    eng
  • Addresses:
    INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France.
Abstract
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 HPLC. This international study evaluated nonadherence in 305 lupus patients with flares using drug levels (HCQ<200ng/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, non-use of steroids, higher BMI 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 under-reporting by patients, suggests that therapeutic drug monitoring is useful in this setting. This article is protected by copyright. All rights reserved.
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