Only 41% of Medicaid patients with lupus receive hydroxychloroquine 2 years post diagnosis
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Just 41% of Medicaid beneficiaries with systemic lupus erythematosus receive hydroxychloroquine or chloroquine within 2 years of diagnosis, according to data published in Arthritis Care & Research.
Meanwhile, factors associated with higher rates of initial treatment with the drug include greater outpatient and preventative care, the researchers noted.
“Medicaid beneficiaries are a vulnerable population and experience a disproportionate burden of lupus and adverse outcomes,” Katherine P. Pryor, MD, MS, of Brigham and Women’s Hospital told Healio Rheumatology. “Although this population as a whole is recognized as being less likely to receive high quality care, including early access to hydroxychloroquine/chloroquine (HCQ/CQ), the cornerstone of SLE treatment, we have a limited understanding of predictors of HCQ/CQ receipt within this population.”
To examine which factors are associated with initial hydroxychloroquine or chloroquine treatment in patients with SLE, Pryor and colleagues studied Medicaid insurance claims from 2000 to 2010. In all, they identified 9,560 beneficiaries aged 18 to 65 years with incident SLE. For this study, the researchers defined incident SLE as at least three SLE ICD-9 codes, separated by at least 30 days without a previous code or hydroxychloroquine use for 24 months.
The primary outcome was the first dispensing of hydroxychloroquine or chloroquine within 24 months of the first SLE code. The researchers used Cox proportional hazards regression models to examine the links between sociodemographic factors and comorbidities, as well as health care and medication use, and hydroxychloroquine or chloroquine dispensing within 24 months of the initial SLE diagnosis.
According to the researchers, a total of 3,949 identified patients received hydroxychloroquine — and 14 treated with chloroquine — within 24 months of SLE diagnosis. Younger patients were more likely to receive either drug than those who were older, while Black, Asian, Hispanic and American Indian/Alaska Native individuals were more likely to receive them than white patients.
Alcohol, opioid and nicotine use, as well as diabetes and end‐stage renal disease were all associated with lower dispersal rates. Meanwhile, outpatient appointments and preventive care services were associated with higher rates. Increased hospitalizations were associated with lower rates.
“Only 41% of Medicaid beneficiaries with SLE receive HCQ/CQ within 2 years of diagnosis,” Pryor said. “Although prior studies have shown poorer quality metrics and a higher burden of adverse outcomes among Black and Hispanic individuals with lupus relative to white individuals, our findings suggest that initial HCQ/CQ dispensing differences do not explain racial/ethnic disparities in adverse outcomes.”
“Additionally, that patients who receive HCQ/CQ are overall healthier than those who don’t suggests we should be cautious in our interpretation of observational studies comparing outcomes between HCQ/CQ users and non-users,” she added. “Predictors of receipt or non-receipt are important in the development of modifiable and targeted strategies to improve outcomes.”
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