Lupus study by FHS researchers show hydroxychloroquine adherence with associated with lower mortality

In a recent study by Faculty of Health Sciences (FHS) PhD student Md Rashedul Hoque, systemic lupus erythematosus (SLE) patients who take their antimalarial medications – hydroxychloroquine - regularly have a 71% lower risk of death than those who do not take them regularly, and an 83% reduced risk than those who discontinue use altogether. This research is important, as their study confirms that 60% of SLE patients are non-compliant with prescribed antimalarials.

“SLE is a chronic inflammatory autoimmune disease that leads to excessive morbidity, including premature mortality. One key factor to avoid complications and premature deaths is to adhere to prescribed antimalarials, which is the first-line drug in SLE management for most patients, for its numerous benefits,” Hoque explains. “That motivated us to assess the effects of time-varying antimalarials adherence on premature mortality among SLE patients, which is, to our knowledge, the very first population-based study on this topic.”

These antimalarial medications have been shown to improve SLE symptoms and reduce inflammation of the lining of the heart and lungs, the development of kidney inflammation, central nervous system impairment, and flares in disease activity. Despite the benefits of taking hydroxychloroquine for lupus patients, including improved quality of life and longevity, the patients frequently do not adhere to the medication regimes. Some known reasons for non-adherence from previous research included cost of medications, income, personal beliefs and fear about adverse effects, having problems remembering doses, living rurally, lower education level, and polypharmacy.

Hoque’s research, supervised by FHS professor Hui Xie, point out that SLE patients discontinued antimalarial therapy in 44% of the follow up periods after first antimalarial prescriptions, whereas in 16% and 40% of the follow up periods they took less than 90% of the recommended doses (non-adherent), and at least 90% of the recommended doses (adherent), respectively.

 “The results of this study call attention to the need for improved strategies to boost antimalarial adherence among SLE patients to increase survival and prevent premature death,” says Xie.

While accessibility to antimalarial drugs may be an issue for some patients, they recommend that patients speak to their physicians to address these issues. Physicians and patients can discuss education programs and individual strategies that improve adherence; health authorities, providers, physician associations, and patient advocacy groups are urged to come up with ways to address the poverty/systemic factors contributing to drug non-adherence.

Hoque and Xie hope their findings will motivate rheumatologists and other physicians to encourage SLE patients to adhere to their antimalarial drug regimens.