Effect of level of adherence of antimalarials on disease activity and its determinants in Systemic lupus erythematous patients on follow up at rheumatology clinic of Tikur Anbessa Specialized Hospital
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Date
2024-05
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Addis Ababa University
Abstract
Background: Systemic lupus erythematous (SLE) is an autoimmune disease associated with
accrual of organ damage and mortality. Antimalarials like Hydroxychloroquine/Chloroquine are
important therapeutic options in SLE. But their effectiveness is impeded by non-adherence.
Objective: To assess the level of adherence of antimalarials, its determinants and its association
to disease activity in SLE patients on follow up at the rheumatology clinic of Tikur Anbessa
Specialized Hospital (TASH).
Methods: 106 SLE patients taking antimalarials and who had follow up visit from August 1 to
October 31 2023 were included in the study. Structured questionnaire was used to assess their
sociodemographic and clinical characteristics. Adherence was assessed using Morisky
medication adherence scale (MMAS-8) and SLE disease activity was assessed using systemic
lupus erythematous disease activity index 2000 (SLEDAI-2K). Data was analyzed using
statistical package for social science (SPSS) version 26. Binary logistic regression was used to
assess the association between level of adherence and disease activity and to look for clinical
predictors of non-adherence. Statistical significance was determined using adjusted odds ratio at
95% confidence interval (CI) and P value <0.05.
Results: 98.1% were women and the mean age of the patients was 28.8 years. 91.5% were on
chloroquine and 8.5% were taking hydroxychloroquine. 11.3% were on high dose prednisolone.
36.8% of patients were found to be non-adherent to their antimalarials and 53.8% had active
disease. Non adherence was seen to have a significant association with active disease (AOR 9.86
95% CI 3.61, 26.87). None of the sociodemographic and clinical factors were found to be
predictors of non-adherence. (P>0.2)
Conclusion: SLE patients in this study had a fair adherence to antimalarials. There is a strong
association between non-adherence to antimalarial and active disease in SLE patients.
Sociodemographic and clinical factors were not found to be predictors of medication adherence.
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Keywords
SLE, Antimalarials, adherence, and Disease activity