A Prospective International Study on Adherence to Treatment in 305 Patients With Flaring SLE: Assessment by Drug Levels and Self-Administered Questionnaires

Nathalie Costedoat-Chalumeau*, Frédéric Houssiau, Peter Izmirly, Véronique Le Guern, Sandra Navarra, Meenakshi Jolly, Guillermo Ruiz-Irastorza, Gabriel Baron, Eric Hachulla, Nancy Agmon-Levin, Yehuda Shoenfeld, Francesca Dall'Ara, Jill Buyon, Christophe Deligny, Ricard Cervera, Estibaliz Lazaro, Holy Bezanahary, Gaëlle Leroux, Nathalie Morel, Jean François ViallardChristian Pineau, Lionel Galicier, Ronald Van Vollenhoven, Angela Tincani, Hanh Nguyen, Guillaume Gondran, Noel Zahr, Jacques Pouchot, Jean Charles Piette, Michelle Petri, David Isenberg

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Nonadherence to treatment is a major cause of lupus flares. Hydroxychloroquine (HCQ), a major medication in systemic lupus erythematosus, has a long half-life and can be quantified by high-performance liquid chromatography. This international study evaluated nonadherence in 305 lupus patients with flares using drug levels (HCQ <200ng/ml or undetectable desethylchloroquine), and self-administered questionnaires (MASRI <80% or MMAS-8 <6). Drug levels defined 18.4% of the patients as severely nonadherent. In multivariate analyses, younger age, nonuse of steroids, higher body mass index, and unemployment were associated with nonadherence by drug level. Questionnaires classified 39.9% of patients as nonadherent. Correlations between adherence measured by questionnaires, drug level, and physician assessment were moderate. Both methods probably measured two different patterns of nonadherence: self-administered questionnaires mostly captured relatively infrequently missed tablets, while drug levels identified severe nonadherence (i.e., interruption or erratic tablet intake). The frequency with which physicians miss nonadherence, together with underreporting by patients, suggests that therapeutic drug monitoring is useful in this setting.

Original languageEnglish
Pages (from-to)1074-1082
Number of pages9
JournalClinical Pharmacology and Therapeutics
Issue number6
Publication statusPublished - 1 Jun 2018

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