Many poorer patients with
the auto-immune disease lupus don't take their medications as prescribed, a new
US study suggests.
Researchers found that
lupus patients on Medicaid – the public health insurance program for the poor – were often not sticking with their prescriptions. Over six months, patients
picked up enough medication to cover only 31% to 57% of those days.
The findings are
concerning, experts say, not only because lupus drugs can help send symptoms
into remission, but because they may also stave off some of the long-term
consequences of the disease.
said lead researcher Dr Jinoos Yazdany, of the University of California, San
Francisco. "These medications have a proven track record of improving
The study used pharmacy
claims data, so it's not possible to say why people were not taking their
medication as prescribed, Yazdany said.
But money could be one
factor. Medicaid covers the drugs, Yazdany noted, but even a small co-pay could
be a barrier for low-income patients.
Drug side effects could be
another issue, Yazdany said, as could a lack of education about the
medications. "Some people may not be fully aware of the benefits of these
drugs," she said.
Yazdany is scheduled to
present the findings Saturday, at the American College of Rheumatology's annual
meeting in San Diego.
The most common form of
lupus is systemic lupus erythematosus (SLE). In SLE, the immune system attacks
the body's own tissue, damaging the skin, joints, heart, lungs, kidneys and
The disease mostly strikes
women, usually starting in their 20s or 30s.
Lupus drugs include
immune-system suppressors, such as cyclophosphamide (Cytoxan) and tacrolimus
(Prograf), and anti-malaria drugs, such as hydroxychloroquine (Plaquenil),
which can ease the fatigue, joint pain and skin rash seen in lupus.
Part of the goal is to
control symptom flare-ups, including fatigue, fever, joint pain and skin rash.
But the drugs can also reduce organ damage that can lead to kidney failure and
The study included 23 187
Medicaid patients, mostly women, who were prescribed at least one drug for
lupus. Yazdany's team used pharmacy claims to gauge whether patients were
sticking with their prescribed regimen.
In general, patients lacked
medication for a substantial proportion of the six months. But black, Hispanic
and Native American patients were less compliant than white and Asian patients – with only enough medication to cover a little more than half of the time
period. And people living in the Midwest were less compliant than residents of
Overall, fewer than
one-third of all patients had enough medication to cover at least 80% of the
Dr Cristina Drenkard, an
assistant professor at Emory School of Medicine in Atlanta, said this finding
is "very concerning".
Low-income minorities with
lupus are known to fare worse than their white counterparts, and the reasons
are probably many, noted Drenkard, whose research focuses on lupus. But it's
likely that lesser adherence to drug regimens is one reason, she said.
Drenkard and her colleagues
recently published a small study looking at whether a
"self-management" program could help low-income black women with
lupus. And they found that women who attended workshops at a public clinic were
feeling better and doing a better job of taking their medication and generally
managing their disease.
self-management support like this is important for people with SLE,"
Still, a program like that
would be only one part of the solution, these experts added.
"We need more research
to understand what the barriers are to drug adherence, from the patient point
of view," Yazdany said.
Another study to be
reported at the same meeting underscores the importance of sticking with
prescriptions. Researchers found that among more than 1 700 lupus patients in
11 countries, those taking anti-malaria drugs were less likely to show damage
to their kidneys, heart or other organs over six years.
Do lupus patients with
private insurance do a better job of sticking with their medications? It's not
clear, said Yazdany. With Medicaid, there are state databases to comb through,
but there is no similar way to study lupus patients with private insurance on a
For now, Yazdany said it's
important for all lupus patients to bring any medication concerns to their
doctor. If side effects are an issue, she said, your doctor may be able to
adjust the dose or switch the medication.
"We have more [drug]
options available now than we used to," Yazdany said. "So there's a
good chance that something else will work for you."
Data and conclusions
presented at meetings are typically considered preliminary until published in a
peer-reviewed medical journal.
The Lupus Foundation of
America answers common questions about this auto-immune