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Medication compliance is an important aspect of disease management and treatment. One aspect of compliance is filling recommended prescriptions.

In a retrospective cohort study in by Davis and colleagues, patients with systemic erythematous lupus (SLE) between ages 10-24 were evaluated for immunosuppressant prescription fills within first year of diagnosis. Data collected included prescription fills of hydroxychloroquine, immunosuppressants (mycophenolate mofetil, azathioprine, leflunomide, methotrexate, calcineurin inhibitors and cyclophosphamide), and glucocorticoids. Baseline data regarding disease activity excluding nephritis and central nervous system disease were not included.

The majority of patients in the cohort were female (87%) with a mean age of 18.5. There was a disproportionate number of white patients (62%) compared to Black (17%) and Hispanic (14%). This study included privately insured and Medicare Advantage patients. A total of 532 patients were included: 78% (413) filled immunosuppressant prescriptions within first year; 69% (366) filled hydroxychloroquine; 34% (182) other immunosuppressants; and 64% (340) filled glucocorticoids.

These numbers were lower at the 3-month and 6-month marks.

While the numbers for prescription fills within first 3-12 months weren't very high, researchers did find that those with childhood-onset SLE (ages 10-17) had an increased odds ratio of filling immunosuppressants (OR 0.56 P=0.021) within their first year. It is unclear if factors such as greater social support, supervision, etc., could be associated with these findings. In addition, there were only 199 childhood-onset patients (37%) compared to 333 adult-onset patients (63%). An increased odd of filling immunosuppressants in the subsequent calendar year was also seen (OR 1.10 P<0.001).

This study reinforces the low prescription fill rates of SLE patients, which is alarming as early disease treatment is thought to be a key feature in successful rheumatic disease management. Compliance is also determined by how the medication is taken at home, which was not addressed in this study. There was no statistically significant association between demographic and disease factors and time to prescription fill; however, further studies should be done to help delineate this as we know that several factors influence medication nonadherence in adults.

Sneha Patel, MD, practices rheumatology in Fort Worth, Texas.

Read the study here and a Q&A with the first author here.