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<p>Cutaneous lupus erythematosus (CLE) is a photosensitive autoimmune condition that causes decreased quality of life due to alterations in physical appearance. Poor medication adherence has been linked to impaired disease outcomes and quality of life in patients with systemic lupus erythematosus (SLE), but there is a paucity of adherence studies for those with CLE. Furthermore, patients with CLE face unique challenges in medication adherence due to decreased quality of life compared to patients with isolated SLE and cost of treatments. This retrospective cohort study describes the 90-day oral medication non-adherence rate for patients with CLE at a safety-net hospital and explores risk factors associated with non-adherence. Patients were recruited from an outpatient dermatology clinic at Parkland Health. Inclusion criteria included dermatologist-diagnosed CLE, age ≥18 years, prescribed oral lupus medications, and 90+ days of continuous refill data. Exclusion criteria included external pharmacy refills and medications dispensed at a 3-month supply. Non-adherence was defined as a variable medication possession ratio &lt; 80%. Secondary exploratory covariates were collected via manual chart review, including demographic, medication, and disease-related variables. Univariate analyses included chi-square test for categorical variables and Mann-Whitney U test for continuous variables, and multivariable logistic regression used univariate variables with <i>p</i> &lt; 0.10 and those predefined a priori. Significance was defined at <i>p</i> &lt; 0.05. 120 patients met the inclusion and exclusion criteria, of which 70 (58.3%) were non-adherent. Black, non-Hispanic race/ethnicity was associated with 3.39 times risk of non-adherence (71.4% non-adherent vs. 28.6% for other race/ethnicity, 95% CI 1.50–7.70, <i>p</i> = 0.003). Twice-daily dosing was associated with a 2.81 times greater risk of non-adherence compared to once daily dosing (60.0% non-adherent vs. 30.0% for once-daily, 95% CI 1.16–6.79, <i>p</i> = 0.02). This non-adherence rate was slightly higher than rates reported for other dermatologic conditions. Our results corroborate other studies finding increased rates of non-adherence among minority patients, but future studies will need to identify likely socioeconomic mediators of this relationship. Our study is limited by its single-center retrospective design and limitations in accessible electronic medical record data. Future larger multicenter studies can identify reasons for non-adherence and guide interventions that improve patient outcomes.</p>

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Increased oral medication non-adherence in patients with cutaneous lupus erythematosus at a safety net hospital

  • 期刊论文

  • 发表日期：

    2026年8月3日

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  • Curtis Liu,
  • Maya Adams,
  • L. Steven Brown,
  • Benjamin F. Chong

摘要

Cutaneous lupus erythematosus (CLE) is a photosensitive autoimmune condition that causes decreased quality of life due to alterations in physical appearance. Poor medication adherence has been linked to impaired disease outcomes and quality of life in patients with systemic lupus erythematosus (SLE), but there is a paucity of adherence studies for those with CLE. Furthermore, patients with CLE face unique challenges in medication adherence due to decreased quality of life compared to patients with isolated SLE and cost of treatments. This retrospective cohort study describes the 90-day oral medication non-adherence rate for patients with CLE at a safety-net hospital and explores risk factors associated with non-adherence. Patients were recruited from an outpatient dermatology clinic at Parkland Health. Inclusion criteria included dermatologist-diagnosed CLE, age ≥18 years, prescribed oral lupus medications, and 90+ days of continuous refill data. Exclusion criteria included external pharmacy refills and medications dispensed at a 3-month supply. Non-adherence was defined as a variable medication possession ratio < 80%. Secondary exploratory covariates were collected via manual chart review, including demographic, medication, and disease-related variables. Univariate analyses included chi-square test for categorical variables and Mann-Whitney U test for continuous variables, and multivariable logistic regression used univariate variables with p < 0.10 and those predefined a priori. Significance was defined at p < 0.05. 120 patients met the inclusion and exclusion criteria, of which 70 (58.3%) were non-adherent. Black, non-Hispanic race/ethnicity was associated with 3.39 times risk of non-adherence (71.4% non-adherent vs. 28.6% for other race/ethnicity, 95% CI 1.50–7.70, p = 0.003). Twice-daily dosing was associated with a 2.81 times greater risk of non-adherence compared to once daily dosing (60.0% non-adherent vs. 30.0% for once-daily, 95% CI 1.16–6.79, p = 0.02). This non-adherence rate was slightly higher than rates reported for other dermatologic conditions. Our results corroborate other studies finding increased rates of non-adherence among minority patients, but future studies will need to identify likely socioeconomic mediators of this relationship. Our study is limited by its single-center retrospective design and limitations in accessible electronic medical record data. Future larger multicenter studies can identify reasons for non-adherence and guide interventions that improve patient outcomes.