title: Measuring therapeutic adherence in systemic lupus erythematosus with electronic monitoring.
abstract: OBJECTIVE
  We used an electronic monitoring system to quantify adherence to prescribed oral therapies by patients with systemic lupus erythematosus (SLE).
  
  
  METHODS
  Participants were included from a larger longitudinal study cohort of 110 patients recruited from publicly-funded rheumatology clinics, 78 of whom agreed to have their SLE drug therapy electronically monitored for two years with the Medication Events Monitoring System (MEMS®, AARDEX Group). Adherence was determined as the percentage of days (weeks for methotrexate) the patient took the medication as prescribed by the physician. Collected data included SLEDAI; SLICC damage index for SLE (SDI); medical outcome study social support survey (MOS-SSS); Center for Epidemiologic Studies depression scale (CESD); and quality of life (SF-12).
  
  
  RESULTS
  Ninety percent of the cohort was female, 45% were Hispanic, and 49% were African-American. Mean age was 36.3 years, disease duration was 5.9 years, SLEDAI score was 3.2, and SDI score was 0.9. Adherence was 62% for all drugs combined and did not differ significantly for individual medications. Patients with more depression (p < 0.02), and higher number of pills taken daily (p < 0.02) were more likely to be non-adherent. Only one-fourth of the patients had an average adherence of ≥80%; these patients had a better mental component score (SF-12) at 24 months than non-adherent patients (p < 0.01).
  
  
  CONCLUSIONS
  Electronic monitoring demonstrated that only one-fourth of the patients had an adherence rate ≥80%. Polypharmacy and depression were associated with non-adherence.
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: M F
authors.initials: MF
authors.lastname: Marengo
authors.forename: C A
authors.initials: CA
authors.lastname: Waimann
authors.forename: S
authors.initials: S
authors.lastname: de Achaval
authors.forename: H
authors.initials: H
authors.lastname: Zhang
authors.forename: A
authors.initials: A
authors.lastname: Garcia-Gonzalez
authors.forename: M N
authors.initials: MN
authors.lastname: Richardson
authors.forename: J D
authors.initials: JD
authors.lastname: Reveille
authors.forename: M E
authors.initials: ME
authors.lastname: Suarez-Almazor
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D019338:Polypharmacy; D011569:Psychiatric Status Rating Scales; D055815:Young Adult