Improving Lupus Drug Regimen Adherence Among Minorities

Rheumatologists can do better at helping systemic lupus erythematosus patients from racial and ethnic minority groups adhere to their lupus medication regimens, according to a paper published in Arthritis Care & Research.

Researchers from Duke University examined medication adherence barriers from the perspectives of healthcare providers and patients. Their findings suggest more attention should be paid to the logistics of immunosuppressive drug regimens, as well as patients’ personal circumstances and internal motivation to adhere to regimens.¹

Dr. Sun

“Patients from racial minority groups tend to have more severe disease and are at higher risk for poor outcomes if they don’t take their medications,” says lead author Kai Sun, MD, assistant professor of medicine at Duke University, Durham, N.C. “Little has been written about the specifics of why barriers to medication adherence among minority patients exist and how to address them.” So the researchers set out to gain a better understanding of these issues.

Drilling Down

An earlier publication from the same study concluded that Black people are far less likely than white people to adhere to lupus medication regimens. It finds a link between nonadherence and Black patient reports of anxiety and perceptions that their interactions with rheumatologists lack compassion and respect.²

The more recent paper examines barriers to adherence among 12 patients—mostly Black—at a Duke clinic.¹ The researchers interviewed the patients, four of whom adhered to their regimens, eight who did not, as well as 12 providers (n=7) and staff (n=5)—primarily white women (75%) who had worked in the lupus clinic for a median of 3.5 years. The researchers measured adherence by noting the number of prescription refills in the previous three months.

Ten (80%) of the patients were women, and 11 (92%) were Black. Half (n=6) had private insurance. On average, patients had lived with lupus for 12 years. Seven patients (58%) were taking mycophenolate, three (25%) were taking azathioprine and two (17%) were taking methotrexate. An interviewer unaffiliated with the clinic asked patients why they skipped doses, stopped medications or found regimens difficult. A provider in the lupus clinic conducted interviews with other providers and staff.

Barriers Identified

Patients and providers noted several barriers related to obtaining medications:

Cost & insurance—Half of the patients said they could not consistently afford medications because of high deductibles, lapses in coverage and onerous application processes for Medicaid and other programs. Insured patients noted high out-ofpocket costs and expensive copays for multiple prescriptions. Providers and staff noted unclear communication about necessary prescriptions refills.