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Background: Systemic lupus erythematosus (SLE) is an autoimmune disease, characterized by episodes of flares and remissions. Medication non-adherence remains a recurrent issue in SLE, reported by 43% to 75% of patients. Low treatment adherence increases disease activity and hospitalizations. Satisfaction with care and satisfaction with treatment are understudied in SLE, as well as their influence on patient adherence.
Objectives: This study aims to evaluate the impact of satisfaction with care and oral treatment satisfaction on patient medication adherence in SLE.
Methods: We conducted a cross-sectional study at an outpatient rheumatology clinic. We evaluated patients with SLE diagnosis by EULAR/ACR 2019 criteria, ≥18 years old, with ≥2 follow-ups in the past year. We excluded those with other diagnosed immune-mediated diseases, except for secondary Sjogren and antiphospholipid syndrome, and those who did not complete the questionnaires. Treatment adherence was assessed with the Morisky Medication Adherence Scale (MMAS-4). Satisfaction with care was measured with LupusPRO version 1.7, and oral treatment satisfaction with the Treatment Satisfaction Questionnaire for Medication (TSQM). Quality of Life was assessed with LupusQoL. SLE Disease Activity Index 2000 (SLEDAI-2K) was evaluated for disease activity. Sociodemographic and clinical data were retrieved from medical records. Patients with ≥1 point on MMAS-4 were defined as non-adherent for group comparisons.
Results: A total of 46 patients were evaluated, and 42 completed the questionnaires. The majority were women (n = 41/ 97.6%), with a mean (±) age of 38.14 (13.18) years. Most patients were unemployed (n = 27/ 64.3%) and had no financial income (Table 1). The median (interquartile range, IQR) satisfaction with care was 100 (IQR: 87.5 – 100) and the median TSQM score was 83.33 (IQR: 69.44 – 93.75). Patients’ median quality of life by LupusQoL was 77.21 (IQR: 60.79 – 90.63). Most used oral medications were antimalarials (n = 39/ 92.9%), steroids (n = 23/ 54.8%) and mycophenolate mofetil (n = 14/ 33.3%). According to MMAS-4, 27 (64.3%) patients were non-adherent. Non-adherent patients reported more treatment adverse effects and lower scores on the side effects domain by TSQM, compared to the adherent group (p = 0.004). Also, non-adherent patients reported lower scores on LupusQoL (p = 0.010). No difference was found between satisfaction with care scores (Table 2). MMAS-4 negatively correlated with the side effects domain by TSQM (rho = -0.347, p = 0.009), and with LupusQoL score (rho = -0.359, p = 0.003). No significant correlation was found between MMAS-4 and satisfaction with care (rho = -0.045, p = 0.744). Also, MMAS-4 had a significant positive correlation with education (rho = 0.321, p = 0.013).
Sociodemographic data
| Adherent
| Non-adherent
| p | |
|---|---|---|---|
| Age, mean (SD) | 39.6 (± 17.2) | 37.76 (± 10.59) | 0.648 |
| Gender, n (%) | |||
| Women | 15 (100) | 26 (96.3) | 1.00 |
| Men | 0 (0) | 1 (3.7) | |
| Marital status, n (%) | 0.419 | ||
| Single | 8 (53.3) | 10 (37) | |
| Married | 6 (40) | 11 (40.7) | |
| Cohabitation | 0 (0) | 4 (14.8) | |
| Divorced | 1 (6.7) | 2 (7.4) | |
| Employed, n (%) | 6 (40) | 9 (33.3) | 0.666 |
| Economic perception (USD), n (%) | 0.657 | ||
| No income | 9 (60) | 17 (63) | |
| Less than 290 | 4 (26.7) | 4 (14.8) | |
| 290 - 600 | 2 (13.3) | 3 (11.1) | |
| 600 – 1, 1150 | 0 (0) | 1 (3.7) | |
| More than 1, 115 | 0 (0) | 2 (7.4) | |
| Education, n (%) | 0.036 1 | ||
| No studies | 0 (0) | 3 (11.1) | |
| Primary school | 4 (26.7) | 1 (3.7) | |
| Secondary school | 7 (46.7) | 5 (18.5) | |
| High school | 2 (13.3) | 7 (25.9) | |
| University | 1 (6.7) | 3 (11.1) | |
| Postgraduate | 1 (6.7) | 8 (29.6) | |
| Social security, n (%) | 5 (33.3) | 4 (14.8) | 0.242 |
SD: standard deviation
Chi-square test
Clinical characteristics between adherent and non-adherent patients with SLE
| Adherent
| Non-adherent
| p | |
|---|---|---|---|
| Disease duration (years), mean (SD) | 8.73 (± 6.48) | 11.40 (± 7.44) | 0.251 |
| Comorbidities, n (%) | 9 (60) | 16 (61.5) | 0.963 |
| SLEDAI-2K, median (IQR) | 1 (0 – 2) | 4 (0 – 7) | 0.116 |
| SDI ≥1, n (%) | 4 (26.7) | 4 (15.4) | 0.425 |
| Satisfaction with care | 100 (87.5 – 100) | 100 (87.5 – 100) | 0.929 |
| Medication side effects, n (%) | 3 (20) | 15 (55.6) | 0.026 1 |
| TSQM | |||
| Effectiveness, median (IQR) | 73.33 (25.64) | 76.54 (17.52) | 0.636 |
| Convenience, median (IQR) | 70.37 (23.53) | 68.37 (20.59) | 0.767 |
| Side effects, median (IQR) | 100 (100 – 100) | 65.62 (54.68 – 100) | 0.005 2 |
| Global satisfaction, mean (SD) | 81.38 (14.43) | 78.25 (17.49) | 0.561 |
| LupusQoL | |||
| Physical, median (IQR) | 87.5 (78.13 – 93.75) | 78.13 (65.63 – 84.38) | 0.054 |
| Pain, median (IQR) | 100 (83.33 – 100) | 83.33 (58.33 – 91.67) | 0.036 2 |
| Planning, median (IQR) | 100 (83.33 – 100) | 75 (58.33 – 100) | 0.019 2 |
| Intimate relationship, median (IQR) | 100 (75 – 100) | 87.50 (50 – 100) | 0.169 |
| Burden to others, median (IQR) | 91.67 (33.33 – 100) | 58.33 (25 – 83.33) | 0.083 |
| Emotional, median (IQR) | 83.33 (66.67 – 100) | 79.17 (54.17 – 87.50) | 0.055 |
| Body image, median (IQR) | 100 (70 – 100) | 90 (60 – 100) | 0.345 |
| Fatigue, median (IQR) | 75 (62.50 – 100) | 62.5 (43.75 – 81.25) | 0.030 2 |
| Total, median (IQR) | 81.99 (76.64 – 97.27) | 69.51 (56.51 – 82.44) | 0.015 2 |
SD: standard deviation, SLEDAI-2K: SLE Disease Activity Index 2000, IQR: interquartile range, SDI: Systemic Lupus International Collaborating Clinics/American College of Rheumatology - Damage Index, TSQM: Treatment Satisfaction Questionnaire for Medication, LupusQoL: lupus quality of life
Chi-square test
Mann-Whitney U test
Conclusion: More than half (64.3%) of the patients with SLE from our clinic were non-adherent to medication according to MMAS-4. Satisfaction with care was similar between adherent and non-adherent patients. More side effects were reported by the non-adherent patients. Also, non-adherence had a significant negative impact on quality of life by LupusQoL. These findings highlight the importance to address non-adherence in SLE and target associated factors for better disease management and control.
REFERENCES: NIL.
Acknowledgements: NIL.
Disclosure of Interests: None declared.
© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (