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Research ArticleSystemic Lupus Erythematosus

Understanding Nonadherence with Hydroxychloroquine Therapy in Systemic Lupus Erythematosus

Lucy H. Liu, Helene B. Fevrier, Robert Goldfien, Anke Hemmerling and Lisa J. Herrinton
The Journal of Rheumatology October 2019, 46 (10) 1309-1315; DOI: https://doi.org/10.3899/jrheum.180946
Lucy H. Liu
From the Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland; Department of Medicine, Division of Rheumatology, University of California, San Francisco; Division of Research, and Department of Rheumatology, Kaiser Permanente Northern California, Oakland; Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Francisco, San Francisco, California, USA.
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Helene B. Fevrier
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Robert Goldfien
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Anke Hemmerling
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Lisa J. Herrinton
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  • For correspondence: Lisa.Herrinton{at}kp.org
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  • Cohort enrollment. SLE: systemic lupus erythematosus; HCQ: hydroxychloroquine.
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    Figure 1.

    Cohort enrollment. SLE: systemic lupus erythematosus; HCQ: hydroxychloroquine.

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    Table 1.

    Crude OR and 95% CI for associations of 4 WHO dimensions of adherence with adherence ≥ 80% in 1956 Kaiser Permanente patients with SLE and 2 recent prior fills of hydroxychloroquine, Northern California, 2006–14.

    CharacteristicsAdherence ≥ 80%, n = 1132Adherence < 80%, n = 824Crude OR95% CIp
    Socioeconomic status (block-group)
      Median household income, thousands
        15–5426.928.71.00Ref.
        55–7423.123.71.210.94–1.560.13
        75–9924.725.31.040.81–1.330.75
        100–25025.322.31.040.81–1.340.74
      Percent household income below poverty level
        0–3.024.525.51.00Ref.
        3.1–6.525.923.51.030.80–1.330.80
        6.6–12.724.725.90.990.77–1.280.96
        12.8–10024.925.11.150.89–1.480.30
      Percent unemployed
        0–3.726.224.81.00Ref.
        3.8–5.425.025.60.900.70–1.150.40
        5.5–7.223.623.20.970.75–1.250.79
        7.3–2225.226.40.920.72–1.190.54
      Percent high school graduate
        0–1326.325.01.00Ref.
        14–1921.723.51.060.81–1.380.68
        20–2830.131.80.900.71–1.140.37
        29–5921.919.70.870.67–1.130.30
    Patient-related factors
      Age, yrs
        ≤ 3929.434.21.00Ref.
        40–4921.026.60.920.72–1.170.50
        50–6432.025.81.441.14–1.820.00
        65–8917.613.41.531.16–2.030.00
      Sex
        Male10.59.01.00Ref.
        Female89.591.00.840.62–1.140.26
      Race/ethnicity
        African American15.216.90.680.52–0.89< 0.01
        Asian/Pacific Islander19.721.20.700.54–0.90< 0.01
        Hispanic14.119.20.550.42–0.72< 0.0001
        White41.030.81.00Ref.
        Other/unknown*2.23.20.630.46–0.86< 0.001
      Language
        English93.092.31.00Ref.
        Other7.07.70.910.64–1.280.57
    Condition-related factors in the year before index
      Charlson comorbidity index
        083.684.51.00Ref.
        19.26.91.340.96–1.880.09
        ≥ 27.28.60.850.61–1.180.34
      Rheumatology visits
        0–124.029.61.00Ref.
        226.325.11.291.01–1.650.04
        ≥ 349.745.31.351.09–1.680.01
      Hospitalization for any cause
        No81.682.01.00Ref.
        Yes18.418.01.030.81–1.300.82
      eGFR,** ml/min/1.73 m2
        30–590.71.50.530.22–1.320.17
        60–8929.121.11.521.23–1.890.0001
        ≥ 9070.277.41.00Ref.
    Therapy-related factors in the year before index
      Medications (yes vs no)
        Prednisone58.056.91.050.87–1.260.62
        Mycophenolate mofetil15.618.50.810.64–1.030.09
        Azathioprine11.811.51.030.78–1.360.83
        ACE inhibitor20.118.31.120.89–1.410.32
    • Values are % unless otherwise specified.

    • ↵* Includes multiracial, Native American, and unknown.

    • ↵** Missing for 65 patients. WHO: World Health Organization; SLE: systemic lupus erythematosus; eGFR: estimated glomerular filtration rate; ACE: angiotensin-converting enzyme.

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    Table 2.

    Adjusted OR and 95% CI for associations of patient- and condition-related factors* with adherence ≥ 80% in 1956 Kaiser Permanente patients with SLE and 2 recent prior fills of hydroxychloroquine, Northern California, 2006–14.

    VariablesAdjusted OR95% CIp
    Age, yrs
      ≤ 391.00Ref.
      40–490.920.72–1.180.51
      50–641.391.09–1.760.01
      65–891.441.07–1.930.02
    Race
      African American0.740.56–0.970.03
      Asian/Pacific Islander0.760.59–0.990.04
      Hispanic0.590.44–0.77< 0.001
      White1.00Ref.
      Other/unknown0.670.49–0.920.01
    No. rheumatology visits
      0–11.00Ref.
      21.301.01–1.670.04
      ≥ 31.471.18–1.83< 0.001
    • ↵* Other factors in Table 1 were not associated with adherence to a significant degree in the adjusted model. The rheumatologist and the medical center also were not associated with adherence to a significant degree in the adjusted model. SLE: systemic lupus erythematosus.

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Understanding Nonadherence with Hydroxychloroquine Therapy in Systemic Lupus Erythematosus
Lucy H. Liu, Helene B. Fevrier, Robert Goldfien, Anke Hemmerling, Lisa J. Herrinton
The Journal of Rheumatology Oct 2019, 46 (10) 1309-1315; DOI: 10.3899/jrheum.180946

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Understanding Nonadherence with Hydroxychloroquine Therapy in Systemic Lupus Erythematosus
Lucy H. Liu, Helene B. Fevrier, Robert Goldfien, Anke Hemmerling, Lisa J. Herrinton
The Journal of Rheumatology Oct 2019, 46 (10) 1309-1315; DOI: 10.3899/jrheum.180946
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Keywords

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