Stanciu Michèle, Lee Joo-Young Esther, McDonald Emily G, Clark Gregory, Pineau Christian A, Kalache Fares, Grenier Louis-Pierre, Vinet Évelyne, Bernatsky Sasha, Mendel Arielle
McGill University, Montreal, Quebec, Canada.
Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
Lupus Sci Med. 2025 Jan 30;12(1):e001362. doi: 10.1136/lupus-2024-001362.
Patients with SLE take multiple medications. Within a large prospective longitudinal SLE cohort, we characterised medication-related hospitalisations and their preventability.
We identified consecutive admissions to our tertiary hospitals between 2015 and 2020. Two independent adjudicators evaluated if medication-related events contributed to the hospitalisation, considering (1) adverse drug events (ADEs) and (2) events from medication non-adherence, using the Leape and Bates method. We classified ADEs as potentially preventable/ameliorable if we identified modifiable factors. Logistic regressions with generalised estimating equations evaluated associations between participant characteristics and medication-related hospitalisations, accounting for repeat hospitalisations within the same participant.
We studied 68 hospitalisations among 45 participants (91% female). At first hospitalisation, the median age was 38 years (IQR 26.5-53.0) and median SLE duration was 12 years (IQR 5.5-19.5). One or more ADEs contributed to 20 (29%) hospitalisations (11/23 (48%) ADEs being preventable/ameliorable), and SLE flares associated with medication non-adherence contributed to 7 (10%) hospitalisations. Adjusting for age and sex, current prednisone use (adjusted OR (aOR) 3.7, 95% CI 1.1 to 13.0) or ≥1 current immunosuppressant (aOR 11.5, 95% CI 2.7 to 50.0), renal involvement at SLE diagnosis (aOR 6.5, 95% CI 2.7 to 15.7) and polypharmacy (≥5 medications; aOR 11.3, 95% CI 1.2 to 103.8) were associated with having an ADE-related (vs non-ADE) hospitalisation. Age at SLE diagnosis<18 years (OR 5.9, 95% CI 1.3 to 26.6) was associated with hospitalisation for a flare related to non-adherence.
Forty per cent of SLE hospitalisations were medication-related, while half were potentially preventable/ameliorable. Renal involvement, polypharmacy, prednisone and immunosuppressant use were associated with hospitalisation related to an ADE, highlighting a vulnerable group.
系统性红斑狼疮（SLE）患者服用多种药物。在一个大型前瞻性纵向SLE队列中，我们对与药物相关的住院情况及其可预防性进行了特征描述。
我们确定了2015年至2020年间在我们三级医院的连续入院病例。两名独立的判定人员使用Leape和Bates方法评估与药物相关的事件是否导致了住院，考虑因素包括（1）药物不良事件（ADEs）和（2）药物不依从事件。如果我们识别出可改变的因素，就将ADEs分类为潜在可预防/可改善的。使用广义估计方程的逻辑回归评估参与者特征与与药物相关的住院之间的关联，同时考虑同一参与者的重复住院情况。
我们研究了45名参与者中的68次住院情况（91%为女性）。首次住院时，中位年龄为38岁（四分位间距26.5 - 53.0），SLE中位病程为12年（四分位间距5.5 - 19.5）。一种或多种ADEs导致了20次（29%）住院（11/23（48%）的ADEs是可预防/可改善的），与药物不依从相关的SLE病情发作导致了7次（10%）住院。在调整年龄和性别后，当前使用泼尼松（调整后的比值比（aOR）3.7，95%置信区间1.1至13.0）或≥1种当前免疫抑制剂（aOR 11.5，95%置信区间2.7至50.0）、SLE诊断时存在肾脏受累（aOR 6.5，95%置信区间2.7至15.7）以及联合用药（≥5种药物；aOR 11.3，95%置信区间1.2至103.8）与ADE相关（相对于非ADE）的住院相关。SLE诊断时年龄<18岁（比值比5.9，95%置信区间1.3至26.6）与因不依从导致的病情发作住院相关。
40%的SLE住院与药物相关，而其中一半是潜在可预防/可改善的。肾脏受累、联合用药、泼尼松和免疫抑制剂的使用与ADE相关的住院有关，突出了一个脆弱群体。
