SATURDAY Oct. 26 (HealthDay News) -- Many poorer patients with
the autoimmune disease lupus don't take their medications as
prescribed, a new U.S. study suggests.
Researchers found that lupus patients on Medicaid -- the public
health insurance program for the poor -- were often not sticking
with their prescriptions. Over six months, patients picked up
enough medication to cover only 31 percent to 57 percent of those
The findings are concerning, experts say, not only because lupus
drugs can help send symptoms into remission, but because they may
also stave off some of the long-term consequences of the
"It's alarming," said lead researcher Dr. Jinoos Yazdany, of the University of California, San Francisco. "These medications have a proven track record of improving patients' outcomes."
The study used pharmacy claims data, so it's not possible to say
why people were not taking their medication as prescribed, Yazdany
But money could be one factor. Medicaid covers the drugs,
Yazdany noted, but even a small co-pay could be a barrier for
Drug side effects could be another issue, Yazdany said, as could
a lack of education about the medications. "Some people may not be
fully aware of the benefits of these drugs," she said.
Yazdany is scheduled to present the findings Saturday, at the
American College of Rheumatology's annual meeting in San Diego.
The most common form of lupus is systemic lupus erythematosus
(SLE). In SLE, the immune system attacks the body's own tissue,
damaging the skin, joints, heart, lungs, kidneys and brain.
The disease mostly strikes women, usually starting in their 20s
Lupus drugs include immune-system suppressors, such as
cyclophosphamide (Cytoxan) and tacrolimus (Prograf), and
anti-malaria drugs, such as hydroxychloroquine (Plaquenil), which
can ease the fatigue, joint pain and skin rash seen in lupus.
Part of the goal is to control symptom flare-ups, including
fatigue, fever, joint pain and skin rash. But the drugs can also
reduce organ damage that can lead to kidney failure and heart
The study included 23,187 Medicaid patients, mostly women, who
were prescribed at least one drug for lupus. Yazdany's team used
pharmacy claims to gauge whether patients were sticking with their
In general, patients lacked medication for a substantial
proportion of the six months. But black, Hispanic and Native
American patients were less compliant than white and Asian patients
-- with only enough medication to cover a little more than half of
the time period. And people living in the Midwest were less
compliant than residents of other regions.
Overall, fewer than one-third of all patients had enough
medication to cover at least 80 percent of the study period.
Dr. Cristina Drenkard, an assistant professor at Emory School of
Medicine in Atlanta, said this finding is "very concerning."
Low-income minorities with lupus are known to fare worse than
their white counterparts, and the reasons are probably many, noted
Drenkard, whose research focuses on lupus. But it's likely that
lesser adherence to drug regimens is one reason, she said.
Drenkard and her colleagues recently published a small study
looking at whether a "self-management" program could help
low-income black women with lupus. And they found that women who
attended workshops at a public clinic were feeling better and doing
a better job of taking their medication and generally managing
"We think self-management support like this is important for people with SLE," Drenkard said.
Still, a program like that would be only one part of the
solution, these experts added.
"We need more research to understand what the barriers are to drug adherence, from the patient point of view," Yazdany said.
Another study to be reported at the same meeting underscores the
importance of sticking with prescriptions. Researchers found that
among more than 1,700 lupus patients in 11 countries, those taking
anti-malaria drugs were less likely to show damage to their
kidneys, heart or other organs over six years.
Do lupus patients with private insurance do a better job of
sticking with their medications? It's not clear, said Yazdany. With
Medicaid, there are state databases to comb through, but there is
no similar way to study lupus patients with private insurance on a
For now, Yazdany said it's important for all lupus patients to
bring any medication concerns to their doctor. If side effects are
an issue, she said, your doctor may be able to adjust the dose or
switch the medication.
"We have more [drug] options available now than we used to," Yazdany said. "So there's a good chance that something else will work for you."
Data and conclusions presented at meetings are typically
considered preliminary until published in a peer-reviewed medical
The Lupus Foundation of America answers common questions about
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