Adherence to treatment and SLE by Prof Nathalie Costedoat-Chalumeau, Hospital Cochin, Centre de Reference des Maladies Autoimmunes Systemiques Rares, Hospital Cochin, Paris
Nathalie Costedoat began her presentation by defining adherence to treatment using the World Health Organization (WHO) definition: “The degree to which the person’s behaviour corresponds with the agreed recommendations from a health care provider.”
She explained that the behaviour of non-adherence may be variable. There are poor adherent patients, including patients stopping the treatment for a while and then resuming it, and others are taking only part of the daily dosage.
“Drugs don’t work for patients who don’t take them” – C. Everett Koop, M.D.
The methods used to measure adherence to treatment include asking the patient through an evaluation by the physician, calculating the percentage of honoured visits, counting the rates of refilling prescriptions or counting the tablets. There are doctors who are using electronic medication monitors - registers each time the patient opens a medication bottle to take the treatment. This is very helpful for adherence studies since patients first behave very well and then seem to forget about the monitoring system. Unfortunately, this is expensive and not available in clinical practice.
On an individual level, poor adherence increases mortality, transplant rejection and convulsions. The WHO has suggested that increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments.”
Increasing evidence suggests that Hydroxychloroquine (HCQ) is a good and inexpensive drug in systemic lupus erythematosus. First, its efficacy in preventing SLE flares is well demonstrated. In addition HCQ appears to protect against the occurrence of diabetes, thrombotic events, dyslipidemia, and overall damage accrual in SLE patients.
HCQ assays may also help to prevent lupus flares by detecting noncompliant patients with currently inactive lupus who are at high risk of further flares and by making it possible to conduct specific interventions to improve their adherence.
Nathalie Costedoat shared information about the EULAR scientifically endorsed course on Systematic Lupus Erythematous (SLE) which is a biannual course organized in Pisa, Italy. It began in 2003 as a resident theoretical and practical course, dedicated to young rheumatologists and internists. It is internationally oriented with approximately seventy participants and forty faculty members from all over the world. The course is multidisciplinary: the faculty includes rheumatologists, internists, nephrologists, dermatologists and obstetricians.
The structure of the course consists of 36 lectures and 10 clinical cases (9 presented by course participants) interactively discussed through the “show-vote” system. The costs depend on the type of meeting-room and vary from 1000 euros (triple room) to 1250 euros (excluding travel expenses).
The previous editions were EULAR COURSES, the last one was endorsed and EULAR gave funding for 10 bursaries of 1000 euros each.