Mehat Pavandeep, Atiquzzaman Mohammad, Esdaile John M, AviÑa-Zubieta Antonio, De Vera Mary A
University of British Columbia, Vancouver, and Arthritis Research Centre of Canada, Richmond, British Columbia, Canada.
Arthritis Care Res (Hoboken). 2017 Nov;69(11):1706-1713. doi: 10.1002/acr.23191. Epub 2017 Sep 21.
Medication nonadherence has not been well characterized in systemic lupus erythematosus (SLE). Our objective was to a conduct a systematic review of the literature, examining the burden and determinants of medication nonadherence in SLE.
We conducted a systematic search of Medline (1946-2015), Embase (1974-2015), and Web of Science (1900-2015) databases and selected original studies of SLE patients that evaluated nonadherence to SLE therapies as the primary study outcome. We extracted information on study design, sample size, length of followup, data sources, type of nonadherence problem examined, adherence measures and reported estimates, and determinants of adherence reported in multivariable analyses.
After screening 4,111 titles, 11 studies met the inclusion criteria. Study sample sizes ranged from 32 to 246 patients, and studies were categorized according to data source: self-report (5), electronic monitoring devices (1), clinical records from rheumatology clinics (3), and refill information from pharmacy records (2). Overall, the percentage of nonadherent patients ranged from 43% to 75%, with studies consistently reporting that over half of patients are nonadherent. Studies also showed that up to 33% of patients discontinue therapy after 5 years. Determinants of nonadherence included having depression, rural residence, lower education level, and polypharmacy.
Overall, synthesis of current evidence suggests that the burden of medication nonadherence is substantial in SLE. Findings highlight the importance of developing interventions to support adherence and improve outcomes among patients.
在系统性红斑狼疮（SLE）中，药物治疗不依从性尚未得到充分描述。我们的目的是对文献进行系统综述，研究SLE患者药物治疗不依从性的负担及其决定因素。
我们对Medline（1946 - 2015年）、Embase（1974 - 2015年）和科学网（1900 - 2015年）数据库进行了系统检索，并选择了以评估SLE治疗不依从性作为主要研究结果的SLE患者原始研究。我们提取了关于研究设计、样本量、随访时长、数据来源、所研究的不依从性问题类型、依从性测量方法及报告的估计值，以及多变量分析中报告的依从性决定因素等信息。
在筛选了4111篇标题后，有11项研究符合纳入标准。研究样本量从32例至246例患者不等，研究根据数据来源进行分类：自我报告（5项）、电子监测设备（1项）、风湿病诊所的临床记录（3项）以及药房记录中的再填充信息（2项）。总体而言，不依从患者的比例在43%至75%之间，各研究一致报告超过半数的患者存在不依从情况。研究还表明，高达33%的患者在5年后停止治疗。不依从的决定因素包括患有抑郁症、居住在农村、教育水平较低以及使用多种药物。
总体而言，当前证据的综合分析表明，SLE患者药物治疗不依从性的负担相当大。研究结果凸显了制定干预措施以支持依从性并改善患者治疗结局的重要性。
