ArticleSeminars in arthritis and rheumatism2022
Hydroxychloroquine and immunosuppressant adherence patterns and their association with subsequent hospitalization rates among children with systemic lupus erythematosus.
Article in Seminars in arthritis and rheumatism, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Effect of an Electronic Pill Bottle on Hydroxychloroquine Adherence in Pediatric Lupus: Results of a Novel Direct-to-Family Pilot Trial.ACR open rheumatology · 2025Article
- Therapeutic Hydroxychloroquine Blood Levels Are Associated With Fewer Hospitalizations and Possible Reduction of Health Disparities in Lupus.Arthritis care & research · 2024Article
- Identifying distinct phenotypes of patients with juvenile systemic lupus erythematosus: results from a cluster analysis by the Egyptian college of rheumatology (ECR) study group.BMC pediatrics · 2024Article
- Article
- Analysis of Medication Adherence Status and Influencing Factors in Adolescents with Major Depressive Episodes.Actas espanolas de psiquiatria · 2024Article
- Association of patient copayment and medication adherence in systemic lupus erythematosus.Lupus science & medicine · 2023Article
- Treatment patterns in paediatric and adult patients with SLE: a retrospective claims database study in the USA.Lupus science & medicine · 2023Article
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Abstract
objectivesUsing a representative sample of children with systemic lupus erythematosus (SLE) in the United States, we characterized prescription claim-based hydroxychloroquine and immunosuppressant adherence estimates and evaluated their concurrent and predictive validity.
methodsWe identified children ages 5-18 with SLE in the Truven Health MarketScan® Commercial and Medicaid claims databases (2013-2018). Among new users of hydroxychloroquine and immunosuppressant medications, we calculated proportion of days covered (PDC) over 365 days to estimate adherence by user group (mycophenolate, azathioprine, methotrexate, and any immunosuppressant use). Agreement between adherence estimates was evaluated with intraclass correlation coefficients (ICC) and kappa statistics. Separate negative binomial regression models were used to estimate associations between (a) hydroxychloroquine, (b) immunosuppressant, or (c) concurrent immunosuppressant/hydroxychloroquine non-adherence and subsequent hospitalizations, adjusted for baseline demographics, disease severity, and healthcare utilization.
resultsAmong 423 new hydroxychloroquine/immunosuppressant users, 63% were Medicaid recipients. Sufficient adherence (PDC≥80%) ranged from 33 to 45% for immunosuppressants vs. 51-52% for hydroxychloroquine. Agreement between hydroxychloroquine and immunosuppressant adherence was modest overall, but better for mycophenolate (ICC 0.55) than methotrexate (0.27). Hydroxychloroquine non-adherence was associated with a 2.9-fold higher incidence of subsequent hospitalizations (95% CI [1.2-7.1]), whereas immunosuppressant and concurrent non-adherence were associated with 5.9 [2.4-14.6] and 5.6-fold [2.0-15.5] increased incidence, respectively. Use of concurrent adherence improved upon estimation of hospitalization risk compared to hydroxychloroquine adherence, but not immunosuppressant adherence alone.
conclusionsHydroxychloroquine adherence is an imperfect proxy for adherence to other lupus medications among children with SLE, and therefore assessing immunosuppressant adherence concurrently adds value to hydroxychloroquine adherence assessments. Prescription claims-based immunosuppressant adherence measures are predictive of acute care utilization and may inform population management strategies.
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