Abstract
OBJECTIVE: Medication adherence poses a challenge for young patients with systemic lupus erythematosus (SLE), who experience more active disease and damage than their older counterparts. This study aimed to quantify the rate of medication nonadherence by age and to identify differences in reasons for nonadherence between younger and older patients with SLE. METHODS: We collected responses to the Domains of Subjective Extent of Nonadherence (DOSE-Nonadherence)-SLE questionnaire, a clinical tool validated to measure extent of and reasons for medication nonadherence in SLE. Analysis included 336 surveys completed between February 2020 and June 2024. Proportions and odds ratios (ORs) for extent of and reasons for nonadherence were determined across age groups, and logistic regression was used to determine relationships of nonadherence with age and other covariates. RESULTS: Medication nonadherence differed significantly across age groups 18-29, 30-39, 40-49, and 50+ (P < 0.001). For each increased year of age, self-reported nonadherence decreased by 2% (P < 0.05). Black race and Hispanic ethnicity were also predictive of nonadherence across age groups. The < 30 age group was more likely to report nonadherence due to inability to fill medications on time (OR 3.72, 95% CI 1.53-9.02) and needing to take medicines with food (OR 2.55, 95% CI 1.06-6.13). CONCLUSION: Younger patients reported greater extent of nonadherence, often due to logistical impediments. In addition to counseling young adults with SLE on the importance of medications, rheumatologists should, when possible, offer support to help them overcome challenges in obtaining and taking medicines. Approaches to understanding and intervening on medication nonadherence in SLE may need to be tailored by age.