Hydroxychloroquine and immunosuppressant adherence patterns and their association with subsequent hospitalization rates among children with systemic lupus erythematosus

Chang, Joyce; Costenbader, Karen H.

doi:10.1016/j.semarthrit.2022.152042

Cited by 5 publications

(3 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study utilised de-identified patient-level data from the MarketScan Claims Databases in the USA to provide an overview of SLE disease management patterns and therapies initiated among newly diagnosed patients with cSLE and aSLE; in consideration that there is lack of data on general treatment patterns in adults and few in children. [29][30][31] Antimalarials and glucocorticoids were commonly used therapies among existing and newly diagnosed patients with cSLE and aSLE. Compared with patients with newly diagnosed SLE, patients with existing SLE reported higher use of antimalarials, immunosuppressants and combination therapy in cSLE and aSLE cohorts.…”

Section: Discussionmentioning

confidence: 99%

Treatment patterns in paediatric and adult patients with SLE: a retrospective claims database study in the USA

et al. 2023

View full text Add to dashboard Cite

ObjectiveTo assess real-world treatment regimens and patterns in childhood-onset SLE (cSLE) and adult-onset SLE (aSLE) cohorts, including similarities in treatments, duration of use and adherence.MethodsThis retrospective study utilised data from Merative L.P. MarketScan Research Databases (USA). Index date was the date of first SLE diagnosis (2010–2019). Patients aged <18 years (cSLE) and ≥18 years (aSLE) at index date with confirmed SLE diagnosis and ≥12 months continuous enrolment during pre-index and post-index periods were included. The cohorts were stratified based on the presence (existing) or absence (new) of pre-index SLE. Primary outcomes (post-index period) included treatment regimens (all patients), and adherence (proportion of days covered (PDC)) and discontinuation of therapies initiated within 90 days of diagnosis (new patients). Univariate comparisons between cSLE and aSLE cohorts were performed using Wilcoxon rank-sum and χ2(or Fisher’s exact) tests.ResultscSLE cohort included 1275 patients (mean age=14.1 years) and aSLE cohort included 66 326 patients (mean age=49.7 years). Antimalarials and glucocorticoids were commonly used among new (cSLE=64.4%/62.0%; aSLE=51.8%/49.7%) and existing (cSLE=68.6%/58.9%; aSLE=63.8%/51.3%) patients in both cohorts. Median oral glucocorticoid dose (prednisone equivalent) was higher in cSLE vs aSLE (new=22.1 vs 14.0 mg/day; existing=14.4 vs 12.3 mg/day; p<0.05). Mycophenolate mofetil use was higher in patients with cSLE vs aSLE (new=26.2% vs 5.8%; existing=37.6% vs 11.0%; p<0.0001). Compared with aSLE, more patients used combination therapies in cSLE (p<0.0001). Median PDC was higher in cSLE vs aSLE for antimalarials (0.9 vs 0.8; p<0.0001) and oral glucocorticoids (0.6 vs 0.3; p<0.0001). Treatment discontinuation was lower in cSLE vs aSLE for antimalarials (25.0% vs 33.1%; p<0.0001) and oral glucocorticoids (56.6% vs 71.2%; p<0.0001).ConclusionsManagement of cSLE and aSLE includes the same medication classes; differences include more intensive use of therapy in cSLE, warranting the need for approved safe medications for cSLE.

show abstract

Section: Discussionmentioning

confidence: 99%

Treatment patterns in paediatric and adult patients with SLE: a retrospective claims database study in the USA

et al. 2023

View full text Add to dashboard Cite

show abstract

“…As was shown by another claims data study, concordance between adherence to hydroxychloroquine and adherence to immunosuppressants is only moderate, demonstrating the importance of considering other SLE therapies individually. 40 Our study has some important limitations. Foremost is the potential for misclassification that is inherent to using claims data.…”

Section: Lupus Science and Medicinementioning

confidence: 90%

“…This study also used PDC ≥80% as measure for adherence. 40 A longitudinal cohort with 332 individuals with SLE evaluated the association between patient medication cost concerns (encompassing difficulty affording medications, delaying refills, requesting lower-cost alternatives, etc) and patient-reported outcomes. In this study, the group of patients that expressed medication cost concerns had worse disease activity, depression symptoms, pain, fatigue and poorer sleep compared with the group without medication cost concerns, and this difference persisted over time.…”

Section: Lupus Science and Medicinementioning

confidence: 99%

Association of patient copayment and medication adherence in systemic lupus erythematosus

Lomanto Silva,

Swabe,

Sattui

et al. 2023

Lupus Sci Med

View full text Add to dashboard Cite

ObjectiveTo investigate the association of medication copayment and treatment adherence to hydroxychloroquine and immunosuppressants for SLE.MethodsWe conducted a retrospective analysis of health claims data using Optum’s de-identified Clinformatics Data Mart Database. Individuals with SLE continuously enrolled for 180 days from 1 July 2010 to 31 December 2019 were included. Adherence was defined as the proportion of days covered ≥80%. Copayment for a 30-day supply of medication was dichotomised as high (≥$10) or low (<$10). We examined the association between copayment and odds of adherence in multivariable-adjusted logistic regression models, including age, sex, race or ethnicity, comorbidities, educational attainment and household income.ResultsWe identified 12 510 individuals (age 54.2±15.5 years; 88.2% female sex), of whom 9510 (76%) were prescribed hydroxychloroquine and 1880 (15%) prescribed hydroxychloroquine and an additional immunosuppressant (azathioprine, methotrexate or mycophenolate mofetil). Median (IQR) 30-day copayments were $8 (4–10) for hydroxychloroquine, $7 (2–10) for azathioprine, $8 (3–11) for methotrexate and $10 (5–20) for mycophenolate mofetil. High copayments were associated with OR of adherence of 0.61 (95% CI 0.55 to 0.68) for hydroxychloroquine, OR 0.44 (95% CI 0.30 to 0.66) for azathioprine and OR 0.69 (95% CI 0.49 to 0.96) for mycophenolate mofetil. For methotrexate, the association was not significant.ConclusionIn a large, administrative health claims database, we identified that high copayments were associated with reduced adherence to commonly prescribed medications for SLE. Incorporating awareness of the burden of copayments and its consequences into healthcare is essential to promote optimal medication adherence.

show abstract

Therapeutic Hydroxychloroquine Blood Levels Are Associated With Fewer Hospitalizations and Possible Reduction of Health Disparities in Lupus

Garg,

Astor,

Saric

et al. 2024

Arthritis Care & Research

View full text Add to dashboard Cite

ObjectiveNonadherence to receiving hydroxychloroquine (HCQ) is associated with a three‐fold higher risk of lupus‐related hospitalization. Monitoring HCQ blood levels could improve adherence to receiving HCQ and efficacy. Yet, HCQ level monitoring is not routinely done partially due to cost and coverage concerns. To establish HCQ level monitoring cost‐effectiveness, we reported the following: (1) risk of acute care by HCQ blood levels, and (2) cost of HCQ monitoring versus acute care visits.MethodsHCQ blood levels were measured during routine lupus visits. HCQ levels were categorized as follows: (1) subtherapeutic (<750 ng/mL), (2) therapeutic (750–1,200 ng/mL), or (3) supratherapeutic (>1,200 ng/mL). All lupus‐related acute care visits (emergency room visits/hospitalizations) after the index clinic visit until next follow‐up were abstracted. In our primary analysis, we examined associations between HCQ levels and time to first acute care visit in all patients and subgroups with higher rates of acute care.ResultsA total of 39 lupus‐related acute care visits were observed in 181 patients. Therapeutic HCQ blood levels were associated with 66% lower rates of acute care. In our cohort, two groups, Black or Hispanic patients and those with public insurance, faced three to four times higher rates of acute care. Levels within 750 to 1,200 ng/mL were associated with 95% lower rates of acute care use in subgroups with higher acute care use.ConclusionHCQ blood levels within 750 to 1,200 ng/mL are associated with lower rates of acute care in all patients with lupus, including groups with higher rates of acute care. Future clinical trials should establish the causal association between HCQ level monitoring and acute care in patients with lupus.image

show abstract

Hydroxychloroquine and immunosuppressant adherence patterns and their association with subsequent hospitalization rates among children with systemic lupus erythematosus

Cited by 5 publications

References 25 publications

Treatment patterns in paediatric and adult patients with SLE: a retrospective claims database study in the USA

Treatment patterns in paediatric and adult patients with SLE: a retrospective claims database study in the USA

Association of patient copayment and medication adherence in systemic lupus erythematosus

Therapeutic Hydroxychloroquine Blood Levels Are Associated With Fewer Hospitalizations and Possible Reduction of Health Disparities in Lupus

Contact Info

Product

Resources

About