Medicaid patients did not adhere to drug treatment plans for SLE

SAN DIEGO — Medicaid patients had a poor adherence to all classes of medications used to treat systemic lupus erythematosus, according to research from a nationwide study presented at the American College of Rheumatology annual meeting.

“The fact that less than one in three patients are adhering to many of these medications is alarming,” researcher Jinoos Yazdany, MD, MPH, associate clinical direct, Lupus Clinic, University of California, San Francisco Medical Center, said. “We urgently need to develop interventions to approve adherence.”

Jinoos Yazdany

Researchers examined Medicaid records from 2000 to 2006 and identified 23,187 patients (mean age, 38 years; 94% women) with systemic lupus erythematosus who received either an immunosuppressive (including oral cyclophosphamide, mycophenolate mofetil, methotrexate or tacrolimus) or antimalarial (hydroxychloroquine) drug through an outpatient pharmacy.

Drug adherence was calculated through a medication possession ratio (MPR), defined as the proportion of days covered by the total days’ supply dispensed after the first drug claim. Patients were observed for 180 days. Patients having MRPs greater than or equal to 80% were considered adherent.

Patients (36% from the South) included 40% black, 34% white, 16% Hispanic, 5% Asian and 1% Native American. Tacrolimus had the lowest mean MPR (31.1%) and hydroxychloroquine, the highest (56.9%).

Black patients had a lower adherence for all medications vs. whites. Asians, however, had a higher adherence than whites for many of the drugs. Asians had a significantly higher MRP for hydroxychloroquine use (63%), and black (53%), Hispanic (57%) and Native American (56%) patients had a lower MRP when compared with whites (59%; P<.0001 for group comparisons). Adherence was met by 14% of patients taking tacrolimus and 40% of patients receiving mycophenolate mofetil.

“Although adherence was low across all racial/ethnic groups and regions examined, it was particularly low among blacks, Hispanics and native populations,” the researchers concluded. “These findings suggest that a majority of Medicaid beneficiaries may be at risk for inadequate clinical response because of poor adherence.”

“As we expand Medicaid in this era of health reform, this study illustrates that health insurance coverage and prescription drug coverage alone are not necessarily going to improve outcomes for patients if fundamental issues such as adherence are not addressed,” Yazdany said.

Disclosure: The researchers report no relevant financial disclosures.

For more information:

Yazdany J. #1588: Poor Adherence to Medications for Systemic Lupus Erythematosus Among U.S. Medicaid Beneficiaries. Presented at: the 2013 American College of Rheumatology Annual Meeting; Oct. 26-30, San Diego.