Factors associated with non-adherence to medications in systemic lupus erythematosus: Results from a Swedish survey

Abstract

Objective To identify determinants of medication non-adherence in a Swedish population of systemic lupus erythematosus (SLE). Methods Patients with SLE from Karolinska and Örebro University Hospitals participated in a survey-based cross-sectional study. Demographics, disease activity, organ damage, HRQoL (LupusQol, EQ-5D-5 L), medication non-adherence (<80% on CQR-19 or MASRI) and beliefs about medicines (BMQ) were registered. MASRI was used to report adherence to different drugs/drug classes, categorised into (i) antimalarial agents (AMA), (ii) glucocorticoids and (iii) other SLE medications. Multivariable logistic regression adjusted for age, sex, disease activity and organ damage. Results Among 205 respondents, the median age was 52.0 years (IQR: 34.0–70.0), 86.3% were women, 66.8% were non-adherent to their medications according to CQR-19, and 6.6% and 6.3% were non-adherent to AMA and glucocorticoids, respectively, according to MASRI. Positive beliefs about glucocorticoids (OR; 95% CI: 0.77; 0.59–0.99; p = .039) and medications overall (0.71; 0.52–0.97; p = .029) were protective against non-adherence to glucocorticoids. Anxiety/depression (3.09; 1.12–8.54; p = .029), medication concerns (1.12; 1.05–1.20; p < .001) and belief that medications are overused (1.30; 1.15–1.46; p < .001) or harmful (1.36; 1.19–1.56; p < .001) were associated with medication non-adherence (CQR-19); beliefs in the necessity of medications (0.73; 0.65–0.82; p < .001) and positive beliefs in medications were protective (0.72; 0.60–0.86; p < .001). No associations were found between other investigated factors and medication non-adherence. Conclusions Beliefs about medications were a major determinant of medication non-adherence. Patient education may help alleviate the negative impact of misinformation/unawareness on adherence.