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Prados-Moreno S, Sabio JM, Pérez-Mármol JM, Navarrete-Navarrete N, Peralta-Ramírez MI. Adherencia al tratamiento en pacientes con lupus eritematoso sistémico. Med Clin (Barc) 2018; 150:8-15. [DOI: 10.1016/j.medcli.2017.05.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/12/2017] [Accepted: 05/18/2017] [Indexed: 01/30/2023]
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Britto MT, Rohan JM, Dodds CM, Byczkowski TL. A Randomized Trial of User-Controlled Text Messaging to Improve Asthma Outcomes: A Pilot Study. Clin Pediatr (Phila) 2017; 56:1336-1344. [PMID: 28056541 DOI: 10.1177/0009922816684857] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We enrolled 64 patients age 12 to 22 years with a diagnosis of poorly controlled persistent asthma in a 6-month longitudinal crossover study. During the 3 intervention months, participants created personalized text messages to be sent to their phones. Adherence was objectively monitored in 22 of the participants. The adolescent participants gave high ratings on the acceptability of the text messaging system. Asthma control improved from baseline to month 1 regardless of whether teens were in the texting or control group. While participants were in the texting group, their quality of life improved and worry about their asthma decreased. Receiving the text intervention resulted in an increase in adherence of 2.75% each month relative to no intervention, but the improvements were not sustained. There was modest improvement in asthma control and quality of life outcomes, as well as improved adherence during the texting intervention.
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Affiliation(s)
- Maria T Britto
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jennifer M Rohan
- 2 Boston Children's Hospital, Boston, MA, USA.,3 Harvard Medical School, Boston, MA, USA
| | - Cassandra M Dodds
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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53
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Compliance and persistence with hydroxychloroquine in South Korean patients with systemic lupus erythematosus. Lupus 2017; 27:753-761. [DOI: 10.1177/0961203317742712] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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54
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Costedoat-Chalumeau N, Houssiau F, Izmirly P, Le Guern V, Navarra S, Jolly M, Ruiz-Irastorza G, Baron G, Hachulla E, Agmon-Levin N, Shoenfeld Y, Dall'Ara F, Buyon J, Deligny C, Cervera R, Lazaro E, Bezanahary H, Leroux G, Morel N, Viallard JF, Pineau C, Galicier L, Van Vollenhoven R, Tincani A, Nguyen H, Gondran G, Zahr N, Pouchot J, Piette JC, Petri M, Isenberg D. A Prospective International Study on Adherence to Treatment in 305 Patients With Flaring SLE: Assessment by Drug Levels and Self-Administered Questionnaires. Clin Pharmacol Ther 2017; 103:1074-1082. [PMID: 28925027 DOI: 10.1002/cpt.885] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 01/24/2023]
Abstract
Nonadherence to treatment is a major cause of lupus flares. Hydroxychloroquine (HCQ), a major medication in systemic lupus erythematosus, has a long half-life and can be quantified by high-performance liquid chromatography. This international study evaluated nonadherence in 305 lupus patients with flares using drug levels (HCQ <200 ng/ml or undetectable desethylchloroquine), and self-administered questionnaires (MASRI <80% or MMAS-8 <6). Drug levels defined 18.4% of the patients as severely nonadherent. In multivariate analyses, younger age, nonuse of steroids, higher body mass index, and unemployment were associated with nonadherence by drug level. Questionnaires classified 39.9% of patients as nonadherent. Correlations between adherence measured by questionnaires, drug level, and physician assessment were moderate. Both methods probably measured two different patterns of nonadherence: self-administered questionnaires mostly captured relatively infrequently missed tablets, while drug levels identified severe nonadherence (i.e., interruption or erratic tablet intake). The frequency with which physicians miss nonadherence, together with underreporting by patients, suggests that therapeutic drug monitoring is useful in this setting. (Trial registration: ClinicalTrials.gov: NCT01509989.).
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Affiliation(s)
- Nathalie Costedoat-Chalumeau
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | - Frédéric Houssiau
- Service de Rhumatologie, Cliniques Universitaires Saint-Luc; Pôle de Pathologies Rhumatismales Inflammatoires et Systémiques, Université catholique de Louvain, Brussels, Belgium
| | - Peter Izmirly
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, USA
| | - Véronique Le Guern
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | | | - Meenakshi Jolly
- Rush University Medical Center, Rush Lupus Clinic, Chicago, Illinois, USA
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - Gabriel Baron
- AP-HP, Hôpital Hôtel-Dieu, Centre d'Epidémiologie Clinique, Paris, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Eric Hachulla
- Claude Huriez Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques rares, Université de Lille, Lille, France
| | - Nancy Agmon-Levin
- Sheba Medical Center, Zabludowicz Center for Autoimmune Diseases, Tel-Hashomer, Israel
| | - Yehuda Shoenfeld
- Sheba Medical Center, Zabludowicz Center for Autoimmune Diseases, Tel-Hashomer, Israel
| | - Francesca Dall'Ara
- Rheumatology and Clinical Immunology Unit, Spedali Civili and Dept. of Clinical and Experimental Science-University of Brescia, Italy
| | - Jill Buyon
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, USA
| | - Christophe Deligny
- Pierre-Zobda-Quitman Hospital, Internal Medicine Department, Martinique, France
| | - Ricard Cervera
- Hospital Clínic de Barcelona, Department of Autoimmune Diseases, Barcelona, Spain
| | - Estibaliz Lazaro
- Haut Lévêque Hospital, Internal Medicine Department, Pessac, France
| | - Holy Bezanahary
- Dupuytren Hospital, Internal Medicine Department, Limoges, France
| | - Gaëlle Leroux
- AP-HP, Pitié-Salpêtrière Hospital, Internal Medicine Department, Université Pierre et Marie Curie, Paris, France
| | - Nathalie Morel
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | | | | | - Lionel Galicier
- AP-HP, St Louis Hospital, Clinical Immunology Department, Paris, France
| | - Ronald Van Vollenhoven
- Karolinska University Hospital, Department of Medicine, Unit for Clinical Research Therapy, Inflammatory Diseases, Stockholm, Sweden
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Spedali Civili and Dept. of Clinical and Experimental Science-University of Brescia, Italy
| | - Hanh Nguyen
- University College London, Centre for Rheumatology, London, UK
| | | | - Noel Zahr
- AP-HP, Hopital Pitié-Salpêtrière, Pharmacology Department, Paris, France
| | - Jacques Pouchot
- European Georges Pompidou Hospital, Internal Medicine Department, Paris, France
| | - Jean-Charles Piette
- AP-HP, Pitié-Salpêtrière Hospital, Internal Medicine Department, Université Pierre et Marie Curie, Paris, France
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - David Isenberg
- University College London, Centre for Rheumatology, London, UK
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Iudici M, Pantano I, Fasano S, Pierro L, Charlier B, Pingeon M, Dal Piaz F, Filippelli A, Izzo V. Health status and concomitant prescription of immunosuppressants are risk factors for hydroxychloroquine non-adherence in systemic lupus patients with prolonged inactive disease. Lupus 2017; 27:265-272. [DOI: 10.1177/0961203317717631] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- M Iudici
- Rheumatology Section, Department of Clinical and Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - I Pantano
- Rheumatology Section, Department of Clinical and Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - S Fasano
- Rheumatology Section, Department of Clinical and Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - L Pierro
- Rheumatology Section, Department of Clinical and Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - B Charlier
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy
| | - M Pingeon
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy
| | - F Dal Piaz
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy
| | - A Filippelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy
| | - V Izzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy
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Badawy SM, Barrera L, Sinno MG, Kaviany S, O'Dwyer LC, Kuhns LM. Text Messaging and Mobile Phone Apps as Interventions to Improve Adherence in Adolescents With Chronic Health Conditions: A Systematic Review. JMIR Mhealth Uhealth 2017; 5:e66. [PMID: 28506955 PMCID: PMC5447825 DOI: 10.2196/mhealth.7798] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/28/2017] [Accepted: 04/29/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The number of adolescents with chronic health conditions (CHCs) continues to increase. Medication nonadherence is a global challenge among adolescents across chronic conditions and is associated with poor health outcomes. While there has been growing interest in the use of mHealth technology to improve medication adherence among adolescents with CHCs, particularly text messaging and mobile phone apps, there has been no prior systematic review of their efficacy. OBJECTIVE The purpose of this review was to systematically evaluate the most recent evidence for the efficacy of text messaging and mobile phone apps as interventions to promote medication adherence among adolescents with CHCs. METHODS PubMed, Embase, CENTRAL, PsycINFO, Web of Science, Google Scholar, and additional databases were searched from 1995 until November 2015. An additional hand search of related themes in the Journal of Medical Internet Research was also conducted. The Preferred Reporting Results of Systematic Reviews and Meta-Analyses guidelines were followed. Two reviewers independently screened titles/abstracts, assessed full-text articles, extracted data from included articles, and assessed their quality using Grades of Recommendation, Assessment, Development, and Evaluation criteria. Included studies were described in original research articles that targeted adherence in adolescents with CHCs (12-24 years-old). RESULTS Of the 1423 records examined, 15 met predefined criteria: text messaging (n=12) and mobile phone apps (n=3). Most studies were performed in the United States (11/15, 73%), were randomized-controlled trials (8/15, 53%), had a sample size <50 (11/15, 73%), and included adherence self-report and/or biomarkers (9/15, 60%). Only four studies were designed based on a theoretical framework. Approaches for text messaging and mobile phone app interventions varied across studies. Seven articles (7/15, 47%) reported significant improvement in adherence with moderate to large standardized mean differences. Most of the included studies were of low or moderate quality. Studies varied in sample size, methods of adherence assessment, and definition of adherence, which prohibited performing a meta-analysis. CONCLUSIONS The use of text messaging and mobile phone app interventions to improve medication adherence among adolescents with CHCs has shown promising feasibility and acceptability, and there is modest evidence to support the efficacy of these interventions. Further evaluation of short- and long-term efficacy and cost-effectiveness of these interventions is warranted given the early and evolving state of the science.
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Affiliation(s)
- Sherif M Badawy
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Division of Hematology, Oncology and Stem Cell Transplant, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Zagazig University Faculty of Medicine, Department of Pediatrics, Division of Hematology and Oncology, Zagazig, Egypt
| | - Leonardo Barrera
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Division of Hematology, Oncology and Stem Cell Transplant, Chicago, IL, United States
| | - Mohamad G Sinno
- University of Kansas School of Medicine, Department of Pediatrics, Wichita, KS, United States
| | - Saara Kaviany
- Advocate Children's Hospital, Department of Pediatrics, Oak Lawn, IL, United States
| | - Linda C O'Dwyer
- Northwestern University Feinberg School of Medicine, Galter Health Sciences Library, Chicago, IL, United States
| | - Lisa M Kuhns
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Division of Adolescent Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Lim JS, Yoon HS, Cho S, Park HS. The Delivery Rates of Pathology Test Results to Patients: A Single-Center Experience in a Secondary Referral Center. Ann Dermatol 2017; 29:307-313. [PMID: 28566907 PMCID: PMC5438937 DOI: 10.5021/ad.2017.29.3.307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/29/2016] [Accepted: 08/29/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Delivery of pathology reports to the patient is a key step in the biopsy pathway, which is important for patient safety in dermatology. Automated systems for facilitating such medical process began in 2010 in our hospital, sending short message service to scheduled patients. OBJECTIVE The purpose of this study was to evaluate the delivery of pathology reports to patients and investigate factors that influence this process and annual trends. METHODS We retrospectively reviewed the medical records of all outpatients (n=2,452) who underwent skin biopsy at our department of dermatology in 2009 and 2014. In each year group, we analyzed the proportion of revisiting patients in terms of year, sex, age, season, biopsy method and diagnosis. RESULTS In 2009, a smaller proportion of patients (205; 91.5%) who had undergone shave or excisional biopsy than of those who had undergone punch biopsy returned (781; 98.0%; p<0.001). This trend was not significant in 2014. Whereas there was no significant difference of return visit ratio between men and women in 2009, a higher proportion of women (754; 98.0%) than men (633; 95.6%) re-visited after skin biopsy to confirm their diagnosis in 2014 (p=0.008). Three patients with either a malignant tumor or suspected malignant lesion that required complete excision did not return to our clinic. CONCLUSION Pathology report delivery rates were fairly satisfactory, regardless of year, age, season, and diagnosis. Sex and biopsy method influenced the return visit ratio. More organized follow-up protocols are required to strengthen patient safety and prevent critical patient drop-out.
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Affiliation(s)
- Ji Soo Lim
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hyun-Sun Yoon
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Soyun Cho
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hyun-Sun Park
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
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58
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Costedoat-Chalumeau N, Tamirou F, Le Guern V, Blanchet B, Deligny C, Piette JC. Dosage sanguin de l’hydroxychloroquine dans la prise en charge du lupus systémique : intérêts et limites. Rev Med Interne 2017; 38:77-80. [DOI: 10.1016/j.revmed.2016.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 11/25/2022]
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Loescher LJ, Rains SA, Kramer SS, Akers C, Moussa R. A Systematic Review of Interventions to Enhance Healthy Lifestyle Behaviors in Adolescents Delivered via Mobile Phone Text Messaging. Am J Health Promot 2016; 32:865-879. [PMID: 27923885 DOI: 10.1177/0890117116675785] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To systematically review healthy lifestyle interventions targeted to adolescents and delivered using text messaging (TM). DATA SOURCE PubMed, Embase, CINAHL, PsycINFO, and Web of Science databases. Study Inclusion Criteria: Research articles published during 2011 to 2014; analyses focused on intervention targeting adolescents (10-19 years), with healthy lifestyle behaviors as main variables, delivered via mobile phone-based TM. DATA EXTRACTION The authors extracted data from 27 of 281 articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. DATA SYNTHESIS Adolescent and setting characteristics, study design and rigor, intervention effectiveness, challenges, and risk of bias. RESULTS Across studies, 16 (59.3%) of 27 included non-Caucasians. The gender was split for 22 (81.5%) of 27 studies. Thirteen studies were randomized controlled trials. There was heterogeneity among targeted conditions, rigor of methods, and intervention effects. Interventions for monitoring/adherence (n = 8) reported more positive results than those for health behavior change (n = 19). Studies that only included message delivered via TM (n = 14) reported more positive effects than studies integrating multiple intervention components. Interventions delivered using TM presented minimal challenges, but selection and performance bias were observed across studies. CONCLUSION Interventions delivered using TM have the potential, under certain conditions, to improve healthy lifestyle behaviors in adolescents. However, the rigor of studies varies, and established theory and validated measures have been inconsistently incorporated.
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Affiliation(s)
- Lois J Loescher
- 1 Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA.,2 College of Nursing, The University of Arizona, Tucson, AZ, USA
| | - Stephen A Rains
- 3 Department of Communication, The University of Arizona, Tucson, AZ, USA
| | - Sandra S Kramer
- 4 Arizona Health Sciences Library-Tucson, The University of Arizona, Tucson, AZ, USA
| | - Chelsie Akers
- 3 Department of Communication, The University of Arizona, Tucson, AZ, USA
| | - Renee Moussa
- 1 Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
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60
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Moczygemba LR, Cox LS, Marks SA, Robinson MA, Goode JVR, Jafari N. Homeless patients' perceptions about using cell phones to manage medications and attend appointments. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2016; 25:220-230. [PMID: 27896909 DOI: 10.1111/ijpp.12321] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 09/23/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objectives of this study were to (1) describe homeless persons' access and use of cell phones and their perceptions about using cell phone alerts to help manage medications and attend health care appointments and (2) identify demographic characteristics, medication use and appointment history and perceptions associated with interest in receiving cell phone alerts to manage medications and appointments. METHODS A cross-sectional survey was conducted in 2013 at a homeless clinic in Virginia. The questionnaire comprised items about cell phone usage, ownership and functions such as text messaging. Participants reported medication use and appointment history, perceptions about cell phone alerts and interest in receiving alerts to manage medications and appointments. Descriptive statistics for all variables are reported. Logistic regression was used to examine predictors of interest in using a cell phone to manage medications and appointments. KEY FINDINGS A total of 290 participants completed the survey; 89% had a cell phone. Seventy-seven percent were interested in appointment reminders, whereas 66%, 60% and 54% were interested in refill reminders, medication taking reminders and medication information messages respectively. Those who believed reminders were helpful were more likely to be interested in medication taking, refill and appointment reminder messages compared to those who did not believe reminders were helpful. A history of running out of medicine and forgetting appointments were predictors of interest in refill and appointment reminders. CONCLUSIONS Mobile technology is a feasible method for communicating medication and appointment information to those experiencing or at risk for homelessness.
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Affiliation(s)
- Leticia R Moczygemba
- Health Outcomes and Pharmacy Practice Division, The University of Texas College of Pharmacy, Austin, TX, USA
| | - Lauren S Cox
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Samantha A Marks
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Margaret A Robinson
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Jean-Venable R Goode
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Nellie Jafari
- Allegheny General Hospital, Health-System Pharmacy Administration Resident, Pittsburgh, PA, USA
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Son MB, Sergeyenko Y, Guan H, Costenbader KH. Disease activity and transition outcomes in a childhood-onset systemic lupus erythematosus cohort. Lupus 2016; 25:1431-1439. [PMID: 27013665 PMCID: PMC5035166 DOI: 10.1177/0961203316640913] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective The chronicity and severity of childhood-onset systemic lupus erythematosus (cSLE) necessitate effective transition from pediatric to adult providers. We studied transition outcomes in a cSLE cohort. Methods We identified patients at an adult lupus clinic diagnosed with SLE ≤ 18 years who had been followed by a pediatric rheumatologist. Data extracted from the first three years in adult care ("post-transition period") included: sociodemographics, depression, anxiety, SLE manifestations, SLE Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics/ACR Damage Index for SLE (SLICC) scores, non-adherence, and gaps in care (no appointments in the recommended time frame). Multivariable logistic regression analyses for predictors of: (1) time between pediatric and adult providers, (2) gaps in care, (3) unscheduled utilization (emergency department visits and admissions) (4) depression and/or anxiety were performed, as was a multivariable Poisson regression analysis for number of missed appointments. Results In 50 patients, SLEDAI scores were stable (mean 5.7 ± 5.0 at start vs. 4.7 ± 4.8 at year 3, p = 0.2), but SLICC scores increased (0.46 ± 0.84, vs. 0.78 ± 1.25, p = 0.01). Depression and anxiety increased significantly (10% vs. 26%, p = 0.02). Mean time from last pediatric to first adult provider visit was almost nine months (253 ± 392 days). Nearly 75% of patients had ≥ 1 gap in care. White race, low education level and non-adherence were significantly associated with missed appointments. Conclusion Despite moderate disease activity in this cSLE transition cohort, prolonged time between pediatric and adult providers and gaps in care in the post-transition period occurred. Anxiety and depression were frequently reported. Future work should identify methods to improve transition.
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Affiliation(s)
- M B Son
- 1 Division of Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Y Sergeyenko
- 2 University of Miami Miller School of Medicine, Miami, FL, USA
| | - H Guan
- 3 Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - K H Costenbader
- 3 Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, USA
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Badawy SM, Kuhns LM. Economic Evaluation of Text-Messaging and Smartphone-Based Interventions to Improve Medication Adherence in Adolescents with Chronic Health Conditions: A Systematic Review. JMIR Mhealth Uhealth 2016; 4:e121. [PMID: 27780795 PMCID: PMC5101413 DOI: 10.2196/mhealth.6425] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/04/2016] [Accepted: 10/07/2016] [Indexed: 12/17/2022] Open
Abstract
Background The rate of chronic health conditions (CHCs) in children and adolescents has doubled in the past 20 years, with increased health care costs. Technology-based interventions have demonstrated efficacy to improving medication adherence. However, data to support the cost effectiveness of these interventions are lacking. Objective The objective of this study is to conduct an economic evaluation of text-messaging and smartphone-based interventions that focus on improving medication adherence in adolescents with CHCs. Methods Searches included PubMed MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, and Inspec. Eligibility criteria included age (12-24 years old), original articles, outcomes for medication adherence, and economic outcomes. Results Our search identified 1118 unique articles that were independently screened. A total of 156 articles met inclusion criteria and were then examined independently with full-text review. A total of 15 articles met most criteria but lacked economic outcomes such as cost effectiveness or cost-utility data. No articles met all predefined criteria to be included for final review. Only 4 articles (text messaging [n=3], electronic directly observed therapy [n=1]) described interventions with possible future cost-saving but no formal economic evaluation. Conclusions The evidence to support the cost effectiveness of text-messaging and smartphone-based interventions in improving medication adherence in adolescents with CHCs is insufficient. This lack of research highlights the need for comprehensive economic evaluation of such interventions to better understand their role in cost-savings while improving medication adherence and health outcomes. Economic evaluation of technology-based interventions can contribute to more evidence-based assessment of the scalability, sustainability, and benefits of broader investment of such technology tools in adolescents with CHCs.
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Affiliation(s)
- Sherif M Badawy
- Ann and Robert H Lurie Children's Hospital of Chicago, Department of Pediatrics, Division of Hematology, Oncology, and Stem Cell Transplant, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
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A Critical Review of the Effects of Hydroxychloroquine and Chloroquine on the Eye. Clin Rev Allergy Immunol 2016; 49:317-26. [PMID: 25672591 DOI: 10.1007/s12016-015-8469-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Hydroxychloroquine (HCQ) and chloroquine have been used for more than 50 years to treat systemic lupus erythematosus (SLE) and other rheumatic diseases. In general, these drugs are well tolerated and rarely need to be discontinued because of an adverse systemic reaction. However, both medications can be irreversibly toxic to the retina. A new study indicates that toxicity is not as rare as once believed, but depends critically on daily dosage and duration of use, as well as other risk factors. With attention to dosage and other factors, and with proper screening for early signs of toxicity, HCQ can be prescribed with relative safety even over long periods of time.
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64
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Mok CC, Penn HJ, Chan KL, Tse SM, Langman LJ, Jannetto PJ. Hydroxychloroquine Serum Concentrations and Flares of Systemic Lupus Erythematosus: A Longitudinal Cohort Analysis. Arthritis Care Res (Hoboken) 2016; 68:1295-302. [PMID: 26749299 DOI: 10.1002/acr.22837] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 12/17/2015] [Accepted: 01/05/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To study the relationship between serum hydroxychloroquine (HCQ) concentrations and flares of systemic lupus erythematosus (SLE) in a longitudinal cohort of patients. METHODS Patients who fulfilled ≥4 American College of Rheumatology classification criteria for SLE and had been treated with HCQ for >6 months were studied. Blood was assayed for HCQ levels by tandem mass spectrometry. Patients were serially assessed for disease activity, using the Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) version of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and flares (SELENA flares instrument). Comparison of the mean summated SLEDAI scores over time and rates of flares in groups with different HCQ levels was performed by the Kruskal-Wallis test. RESULTS A total of 276 SLE patients were studied (93% women, mean ± SD age 41.0 ± 13.8 years). The proportion of patients with HCQ levels <10 (total noncompliance), 10-500 (subtherapeutic), and >500 ng/ml (therapeutic) was 11%, 77%, and 12%, respectively. HCQ levels correlated significantly with the prescribed dose but not with body weight or renal function. The prescribed HCQ dose also correlated significantly with baseline SLEDAI scores, indicating that higher doses were used for more active manifestations. After a mean ± SD observation period of 32.5 ± 5.5 months, the mean summated SLEDAI score and the incidence of SLE flares was not statistically different among patients with different baseline HCQ levels. In a subgroup of 73 patients with serologic and clinical remission and having therapeutic HCQ levels, a trend of lower disease activity and fewer incidences of flares was observed. CONCLUSION Noncompliance and subtherapeutic serum HCQ levels were seen frequently in these SLE patients, which was partly due to the low prescribed dose. In patients in remission, higher HCQ concentrations were associated with a trend showing fewer flares over time.
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Mok CC. Therapeutic monitoring of the immuno-modulating drugs in systemic lupus erythematosus. Expert Rev Clin Immunol 2016; 13:35-41. [PMID: 27417340 DOI: 10.1080/1744666x.2016.1212659] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Chi Chiu Mok
- Department of Medicine, Tuen Mun Hospital, Hong Kong, China
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66
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Jolly M, Galicier L, Aumaître O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Boutin DLTH, Asli B, Kahn JE, Pourrat J, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Jallouli M, Leroux G, Cohen-Bittan J, Hulot JS, Arora S, Amoura Z, Piette JC, Costedoat-Chalumeau N. Quality of life in systemic lupus erythematosus: description in a cohort of French patients and association with blood hydroxychloroquine levels. Lupus 2016; 25:735-740. [DOI: 10.1177/0961203315627200] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Objectives Benefits of hydroxychloroquine (HCQ) use on physician reported outcomes are well documented in systemic lupus erythematosus (SLE). We assess for the first time the association and predictive value of blood HCQ levels towards health-related quality of life (HRQOL) in SLE. Methods Data from the PLUS study (a randomized, double-blind, placebo-controlled, multicentre study) were utilized. Blood HCQ levels were quantified by high-performance liquid chromatography along with HRQOL assessments (Medical Outcomes Study-SF-36) at baseline (V1) and month 7 (V2). Results 166 SLE patients’ data were analysed. Mean (SD) age and disease duration were 44.4 (10.7) and 9.3 (6.8) years. Eighty-seven per cent were women. Mean (SD, median, IQR) HCQ concentrations in the blood at V1 were 660 (314, 615, 424) ng/ml and increased to 1020 (632, 906, 781) ng/ml at V2 (mean difference 366 units, 95% confidence interval −472 to −260, p < 0.001). No significant correlations between HCQ concentrations with HRQOL domains at V1 or V2 were noted. There were no differences in HRQOL stratified by HCQ concentrations. HCQ concentrations at V1 or changes in HCQ concentration (V2-V1) were not predictive of HRQOL at V2 or changes in HRQOL (V2-V1). Conclusions No association of HCQ concentrations with current or longitudinal HRQOL were found in SLE.
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Affiliation(s)
- M Jolly
- Rush University Medical Center, Chicago, IL, USA
| | - L Galicier
- Université Paris Diderot, Sorbonne Paris-Cité and AP-HP, Hôpital Saint Louis, service d’immunologie clinique, Paris, France
| | - O Aumaître
- Université de Clermont-Ferrand and CHU Clermont-Ferrand, Hôpital Gabriel Montpied, service de médecine interne, Clermont-Ferrand, France
| | - C Francès
- UPMC, Université Paris 6 and AP-HP, Hôpital Tenon, service de dermatologie allergologie, Paris, France
| | - V Le Guern
- Université Paris-Decartes and AP-HP, Hôpital Cochin, service de médecine interne, Paris, France
| | - F Lioté
- Université Paris-Diderot, Sorbonne Paris-Cité and AP-HP, Hôpital Lariboisière, service de rhumatologie, Paris, France
| | - A Smail
- CHU Amiens, Hôpital Nord, service de médecine interne, Amiens, France
| | - N Limal
- UPEC; AP-HP, Hôpital Henri Mondor, service de médecine interne, Créteil, France
| | - L Perard
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, service de médecine interne, Lyon, France
| | - H Desmurs-Clavel
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, service de médecine interne, Lyon, France
| | - D L T H Boutin
- UPMC, Université Paris 6 and AP-HP, Hôpital Pitié-Salpêtrière, service de médecine interne, Paris, France
| | - B Asli
- Université Paris Diderot, Sorbonne Paris-Cité and AP-HP, Hôpital Saint Louis, service d’immunologie clinique, Paris, France
| | - J-E Kahn
- Hôpital Foch, service de médecine interne, Suresnes, France
| | - J Pourrat
- Université Paul-Sabatier and CHU Toulouse, Hôpital Rangueil, service de néphrologie, Toulouse, France
| | - L Sailler
- Université Paul-Sabatier and CHU Toulouse, Hôpital Purpan, service de médecine interne, Toulouse, France
| | - F Ackermann
- Hôpital Foch, service de médecine interne, Suresnes, France
| | - T Papo
- Université Paris-Diderot, Sorbonne Paris-Cité and AP-HP, Hôpital Bichat Claude-Bernard, service de médecine interne, Paris, France
| | - K Sacré
- Université Paris-Diderot, Sorbonne Paris-Cité and AP-HP, Hôpital Bichat Claude-Bernard, service de médecine interne, Paris, France
| | - O Fain
- Hôpital Saint Antoine, DHU i2B, service de médecine interne, Université Paris 6
| | - J Stirnemann
- Division of General Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | - P Cacoub
- APHP, Département de Médecine Interne et Immunologie clinique, Groupe Hospitalier Pitié Salpétriére Paris, France; DHU Inflammation, Immunopathologie, Biothérapie, Université Pierre et Marie Curie, Paris VI, France; UMR 7211 (UPMC/CNRS), UMR S-959 (INSERM)
| | - M Jallouli
- Université Paris-Decartes and AP-HP, Hôpital Cochin, service de médecine interne, Paris, France
| | - G Leroux
- UPMC, Université Paris 6 and AP-HP, Hôpital Pitié-Salpêtrière, service de médecine interne, Paris, France
| | - J Cohen-Bittan
- UPMC, Université Paris 6 and AP-HP, Hôpital Pitié-Salpêtrière, service de gériatrie Pr Verny, Paris, France
| | - J-S Hulot
- Sorbonne Universités, UPMC Univ Paris 06, AP-HP, Institute of Cardiometabolism and Nutrition (ICAN), F-75013, Paris, France
| | - S Arora
- Rush University Medical Center, Chicago, IL, USA
| | - Z Amoura
- UPMC, Université Paris 6 and AP-HP, Hôpital Pitié-Salpêtrière, service de médecine interne, Paris, France
| | - J-C Piette
- UPMC, Université Paris 6 and AP-HP, Hôpital Pitié-Salpêtrière, service de médecine interne, Paris, France
| | - N Costedoat-Chalumeau
- Université Paris-Decartes and AP-HP, Hôpital Cochin, service de médecine interne, Paris, France
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Ershad Sarabi R, Sadoughi F, Jamshidi Orak R, Bahaadinbeigy K. The Effectiveness of Mobile Phone Text Messaging in Improving Medication Adherence for Patients with Chronic Diseases: A Systematic Review. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e25183. [PMID: 27437126 PMCID: PMC4939231 DOI: 10.5812/ircmj.25183] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 12/08/2014] [Accepted: 12/15/2014] [Indexed: 12/15/2022]
Abstract
Context Medication non-adherence is a commonly observed problem in the self-administration of treatment, regardless of the disease type. Text messaging reminders, as electronic reminders, provide an opportunity to improve medication adherence. In this study, we aimed to provide evidence addressing the question of whether text message reminders were effective in improving patients’ adherence to medication. Evidence Acquisition We carried out a systematic literature search, using the five electronic bibliographic databases: PubMed, Embase, PsycINFO, CINAHL, and the Cochrane central register of controlled trials. Studies were included on the basis of whether they examined the benefits and effects of short-message service (SMS) interventions on medication adherence. Results The results of this systematic review indicated that text messaging interventions have improved patients’ medication adherence rate (85%, 29.34). Included in the review, those who had problems with adherence, or those whom text messaging was most helpful had HIV, asthma, diabetes, schizophrenia and heart disease (73.5%). The period of intervention varied from 1 week to 14 months. The most common study design was randomized controlled trials (RCTs) (66%) carried out in the developed countries. Conclusions This study demonstrated the potential of mobile phone text messaging for medication non-adherence problem solving.
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Affiliation(s)
- Roghayeh Ershad Sarabi
- Health Information Management Department, School of Management and Medical Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
| | - Farahnaz Sadoughi
- Health Information Management Department, School of Management and Medical Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Farahnaz Sadoughi, Health Information Management Department, School of Management and Medical Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188794302, Fax: +98-2188883334, E-mail:
| | - Roohangiz Jamshidi Orak
- Health Information Management Department, School of Management and Medical Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IR Iran
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Silva CA, Aikawa NE, Pereira RMR, Campos LMA. Management considerations for childhood-onset systemic lupus erythematosus patients and implications on therapy. Expert Rev Clin Immunol 2015; 12:301-13. [DOI: 10.1586/1744666x.2016.1123621] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Clovis Artur Silva
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Nadia Emi Aikawa
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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COSTEDOAT-CHALUMEAU NATHALIE, LE GUERN VÉRONIQUE, PIETTE JEANCHARLES. Routine Hydroxychloroquine Blood Concentration Measurement in Systemic Lupus Erythematosus Reaches Adulthood. J Rheumatol 2015; 42:1997-9. [DOI: 10.3899/jrheum.151094] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jallouli M, Galicier L, Zahr N, Aumaître O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Le Thi Huong D, Asli B, Kahn JE, Pourrat J, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Leroux G, Cohen-Bittan J, Sellam J, Mariette X, Blanchet B, Hulot JS, Amoura Z, Piette JC, Costedoat-Chalumeau N. Determinants of hydroxychloroquine blood concentration variations in systemic lupus erythematosus. Arthritis Rheumatol 2015; 67:2176-84. [PMID: 25989906 DOI: 10.1002/art.39194] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 05/05/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Blood concentrations of hydroxychloroquine (HCQ) vary widely among patients with systemic lupus erythematosus (SLE). A pharmacokinetic/pharmacodynamic relationship has been found in different situations, and a very low blood concentration of HCQ is a simple marker of nonadherence to treatment. Therefore, interest in blood HCQ concentration measurement has increased, but little is known about factors that influence blood HCQ concentration variability. This study was undertaken to analyze determinants of blood HCQ concentrations. METHODS We conducted a retrospective analysis of patient data, including data from the Plaquenil Lupus Systemic (PLUS) study, to determine the association of epidemiologic, clinical, and biologic factors with blood HCQ concentrations. Data for nonadherent patients (blood HCQ concentration <200 ng/ml) were excluded. RESULTS To examine homogeneous pharmacologic data, we restricted the analyses of the PLUS data to the 509 SLE patients receiving 400 mg/day. We found no association of ethnicity or smoking with blood HCQ concentrations and no pharmacokinetic drug-drug interaction with antacids or with inhibitors or inducers of cytochrome P450 enzymes. On multivariate analysis, high body mass index (P = 0.008), no treatment with corticosteroids (P = 0.04), increased time between the last tablet intake and measurement of blood HCQ concentrations (P = 0.017), low platelet count (P < 0.001), low neutrophil count (P < 0.001), and high estimated creatinine clearance (P < 0.001) were associated with low blood HCQ concentrations. In 22 SLE patients with chronic renal insufficiency (median serum creatinine clearance 52 ml/minute [range 23-58 ml/minute]) who received 400 mg/day HCQ, the median blood HCQ concentration was significantly higher than that in the 509 patients from the PLUS study (1,338 ng/ml [range 504-2,229 ng/ml] versus 917 ng/ml [range 208-3316 ng/ml]) (P < 0.001). CONCLUSION We provide a comprehensive analysis of determinants of blood HCQ concentrations. Because this measurement is increasingly being used, these data might be useful for clinicians.
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Affiliation(s)
- M Jallouli
- Université Paris-Descartes, AP-HP, Hôpital Cochin, and Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Paris, France
| | - L Galicier
- Université Paris Diderot, Sorbonne Paris Cité, and AP-HP, Hôpital Saint Louis, Paris, France
| | - N Zahr
- Université Pierre et Marie Curie and AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - O Aumaître
- Université de Clermont-Ferrand and Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - C Francès
- Université Pierre et Marie Curie and AP-HP, Hôpital Tenon, Paris, France
| | - V Le Guern
- Université Paris-Descartes, AP-HP, Hôpital Cochin, and Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Paris, France
| | - F Lioté
- Université Paris Diderot, Sorbonne Paris Cité, and AP-HP, Hôpital Lariboisière, Paris, France
| | - A Smail
- CHU Amiens, Hôpital Nord, Amiens, France
| | - N Limal
- AP-HP, Hôpital Henri Mondor, Créteil, France
| | - L Perard
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - H Desmurs-Clavel
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - D Le Thi Huong
- Université Pierre et Marie Curie, AP-HP, Hôpital Pitié-Salpêtrière, and Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides, Paris, France
| | - B Asli
- Université Paris Diderot, Sorbonne Paris Cité, and AP-HP, Hôpital Saint Louis, Paris, France
| | - J-E Kahn
- Université Versailles St. Quentin en Yvelines and Hôpital Foch, Suresnes, France, and Université Paris-Sud and AP-HP, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, France
| | - J Pourrat
- Université Paul Sabatier and CHU Toulouse, Hôpital Rangueil, Toulouse, France
| | - L Sailler
- Université Paul Sabatier and CHU Toulouse, Hôpital Purpan, Toulouse, France
| | - F Ackermann
- Université Versailles St. Quentin en Yvelines and Hôpital Foch, Suresnes, France, and Université Paris-Sud and AP-HP, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, France
| | - T Papo
- Université Paris Diderot, Sorbonne Paris-Cité, and AP-HP, Hôpital Bichat Claude-Bernard, Paris, France
| | - K Sacré
- Université Paris Diderot, Sorbonne Paris-Cité, and AP-HP, Hôpital Bichat Claude-Bernard, Paris, France
| | - O Fain
- Université Pierre et Marie Curie, Inflammation Immunopathology Biotherapy Department, and AP-HP, Hôpital St. Antoine, Paris, France
| | | | - P Cacoub
- Sorbonne Universités, Université Pierre et Marie Curie, UMR 7211, and Inflammation Immunopathology Biotherapy Department, AP-HP, Hôpital Pitié-Salpêtrière, Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides, INSERM UMRS 959, and CNRS, FRE3632, Paris, France
| | - G Leroux
- Université Pierre et Marie Curie, AP-HP, Hôpital Pitié-Salpêtrière, and Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides, Paris, France
| | | | - J Sellam
- AP-HP, Université Pierre et Marie Curie, Inflammation Immunopathology Biotherapy Department, and INSERM UMRS 938, Paris, France
| | - X Mariette
- Université Paris-Sud, INSERM U1012, and AP-HP, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France
| | | | - J S Hulot
- Université Pierre et Marie Curie and AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Z Amoura
- Université Pierre et Marie Curie, AP-HP, Hôpital Pitié-Salpêtrière, and Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides, Paris, France
| | - J C Piette
- Université Pierre et Marie Curie, AP-HP, Hôpital Pitié-Salpêtrière, and Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides, Paris, France
| | - N Costedoat-Chalumeau
- Université Paris-Descartes, AP-HP, Hôpital Cochin, and Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Paris, France
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Ding HJ, Denniston AK, Rao VK, Gordon C. Hydroxychloroquine-related retinal toxicity. Rheumatology (Oxford) 2015; 55:957-67. [PMID: 26428520 DOI: 10.1093/rheumatology/kev357] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Indexed: 11/12/2022] Open
Abstract
HCQ is widely used for the treatment of rheumatic diseases, particularly lupus and RA. It is generally well tolerated, but retinopathy is a concern. Retinopathy is rare, but is sight threatening, generally irreversible and may progress even after cessation of therapy. Damage may be subclinical. Although a number of risk factors have been proposed (such as duration of therapy and cumulative dose), the many exceptions (e.g. retinopathy on low-dose HCQ, or no retinopathy after a very large cumulative dose of HCQ) highlight our limited understanding of the disease process. Novel technologies such as optical coherence tomography (OCT), fundus autofluorescence (FAF) and multifocal electroretinogram (mfERG) may provide the earliest structural and functional evidence of toxicity in these stages. Along with the well-established technique of central visual field testing (10-2 visual fields), these modalities are increasingly being used as part of screening programmes. The ideal single test with high sensitivity and high specificity for HCQ retinopathy has still not been achieved. Screening for HCQ retinopathy remains an area of considerable debate, including issues of when, who and how to screen. Commonly accepted risk factors include receiving >6.5 mg/kg/day or a cumulative dose of >1000 g of HCQ, being on treatment for >5 years, having renal or liver dysfunction, having pre-existing retinopathy and being elderly. HCQ continues to be a valuable drug in treating rheumatic disease, but clinicians need to be aware of the associated risks and to have arrangements in place that would enable early detection of toxicity.
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Affiliation(s)
- Hui Jen Ding
- Department of Medicine, Putrajaya Hospital, Putrajaya, Malaysia, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, The Medical School, University of Birmingham
| | - Alastair K Denniston
- Ophthalmology Department, University Hospitals Birmingham NHS Trust, Queen Elizabeth Hospital Birmingham, Centre for Translational Inflammation Research, College of Medical and Dental Sciences, The Medical School, University of Birmingham and
| | - Vijay K Rao
- Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, The Medical School, University of Birmingham
| | - Caroline Gordon
- Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, The Medical School, University of Birmingham, Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Durcan L, Clarke WA, Magder LS, Petri M. Hydroxychloroquine Blood Levels in Systemic Lupus Erythematosus: Clarifying Dosing Controversies and Improving Adherence. J Rheumatol 2015; 42:2092-7. [PMID: 26428205 DOI: 10.3899/jrheum.150379] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Hydroxychloroquine (HCQ) is used for its effect on systemic lupus erythematosus (SLE) disease activity and longterm benefits. This can be limited by adherence. One way to assess adherence is to measure blood levels. Conflicting data exist regarding blood levels and disease activity. There is disagreement about dosing; rheumatologists recommend weight-based dosing while some other specialists advocate height-based "ideal body weight" dosing. METHODS Patients were prescribed HCQ not exceeding 6.5 mg/kg (max 400 mg/day). In hemodialysis, the dose was 200 mg after each session, and in renal insufficiency it was 200 mg/day. Levels were measured at each visit with a therapeutic range of 500-2000 ng/ml. Patients were divided according to baseline blood level. To assess the effect of measurement and counseling on adherence, we compared the proportion of patients with a level of 500 ng/ml or higher based on the number of prior assessments. RESULTS The proportion of patients with HCQ levels in the therapeutic range differed significantly by age, sex, and Vitamin D level. There was a trend toward lower levels with renal failure. Blood levels were similar regardless of height and ideal body weight. Comparing those with undetectable, subtherapeutic, and therapeutic levels, disease activity decreased (SLE Disease Activity Index 2.92, 2.36, and 2.20, p = 0.04 for trend). At first, 56% were therapeutic, and by the third measurement this increased to 80% (p ≤ 0.0001). CONCLUSION There was a trend toward higher disease activity with lower HCQ levels. Renal failure dosing led to suboptimum levels. We show that weight-based dosing (max 400 mg daily) is appropriate and that height does not appear to influence levels. Measurement, counseling, and repeated testing can increase adherence rates.
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Affiliation(s)
- Laura Durcan
- From the Department of Rheumatology, Johns Hopkins University School of Medicine; Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital, Baltimore; Department of Epidemiology and Public Health, University of Maryland, College Park, Maryland, USA.L. Durcan, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; W.A. Clarke, PhD, Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital; L.S. Magder, MPH, PhD, Department of Epidemiology and Public Health, University of Maryland; M. Petri, MD, MPH, Department of Rheumatology, Johns Hopkins University School of Medicine
| | - William A Clarke
- From the Department of Rheumatology, Johns Hopkins University School of Medicine; Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital, Baltimore; Department of Epidemiology and Public Health, University of Maryland, College Park, Maryland, USA.L. Durcan, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; W.A. Clarke, PhD, Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital; L.S. Magder, MPH, PhD, Department of Epidemiology and Public Health, University of Maryland; M. Petri, MD, MPH, Department of Rheumatology, Johns Hopkins University School of Medicine
| | - Laurence S Magder
- From the Department of Rheumatology, Johns Hopkins University School of Medicine; Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital, Baltimore; Department of Epidemiology and Public Health, University of Maryland, College Park, Maryland, USA.L. Durcan, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; W.A. Clarke, PhD, Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital; L.S. Magder, MPH, PhD, Department of Epidemiology and Public Health, University of Maryland; M. Petri, MD, MPH, Department of Rheumatology, Johns Hopkins University School of Medicine
| | - Michelle Petri
- From the Department of Rheumatology, Johns Hopkins University School of Medicine; Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital, Baltimore; Department of Epidemiology and Public Health, University of Maryland, College Park, Maryland, USA.L. Durcan, MD, Department of Rheumatology, Johns Hopkins University School of Medicine; W.A. Clarke, PhD, Department of Pathology, Clinical Chemistry, Johns Hopkins University Hospital; L.S. Magder, MPH, PhD, Department of Epidemiology and Public Health, University of Maryland; M. Petri, MD, MPH, Department of Rheumatology, Johns Hopkins University School of Medicine
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Potential Limitations of E-mail and Text Messaging in Improving Adherence in Glaucoma and Ocular Hypertension. J Glaucoma 2015; 24:e95-102. [PMID: 25264996 DOI: 10.1097/ijg.0000000000000150] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine how receptive patients are to the use of e-mail and text message reminders for appointments and medications. METHODS We conducted a consecutive cross-sectional survey of eligible patients with glaucoma or ocular hypertension at a private glaucoma subspecialty practice with 3 locations from February 2011 to January 2012. Main outcome measures were answers to survey questions regarding how receptive patients are to e-mail and text messaging reminders for appointments and medications. RESULTS Of 989 patients, 404 (40.8%) patients reported that e-mail reminders would help remember appointments and 185 (18.7%) reported that they would help for medications. Among those with access to text messaging, 280 (68.9%) reported text messaging would help them remember appointments and 193 (47.5%) reported it would help with medications. Patients who reported e-mail would help them remember medications were more likely to live in an urban location [P=0.05, odds ratio (OR)=1.84], check the internet at least daily (P≤0.001, OR=1.04), check e-mail when not at home or the office (P=0.02, OR=1.62), and know how to open attachments (P=0.03, OR=1.87). Patients who reported that text messaging would help them remember their medications were more likely to be 40 or less (P≤0.001, OR=8.54) and African American (P<0.001, OR=2.59). CONCLUSIONS E-mail and text messaging reminders currently may have a limited utility in improving adherence in the general glaucoma population but may be useful in younger patients with glaucoma.
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van Mierlo T, Fournier R, Ingham M. Targeting Medication Non-Adherence Behavior in Selected Autoimmune Diseases: A Systematic Approach to Digital Health Program Development. PLoS One 2015; 10:e0129364. [PMID: 26107637 PMCID: PMC4481109 DOI: 10.1371/journal.pone.0129364] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/07/2015] [Indexed: 01/19/2023] Open
Abstract
Background 29 autoimmune diseases, including Rheumatoid Arthritis, gout, Crohn’s Disease, and Systematic Lupus Erythematosus affect 7.6-9.4% of the population. While effective therapy is available, many patients do not follow treatment or use medications as directed. Digital health and Web 2.0 interventions have demonstrated much promise in increasing medication and treatment adherence, but to date many Internet tools have proven disappointing. In fact, most digital interventions continue to suffer from high attrition in patient populations, are burdensome for healthcare professionals, and have relatively short life spans. Objective Digital health tools have traditionally centered on the transformation of existing interventions (such as diaries, trackers, stage-based or cognitive behavioral therapy programs, coupons, or symptom checklists) to electronic format. Advanced digital interventions have also incorporated attributes of Web 2.0 such as social networking, text messaging, and the use of video. Despite these efforts, there has not been little measurable impact in non-adherence for illnesses that require medical interventions, and research must look to other strategies or development methodologies. As a first step in investigating the feasibility of developing such a tool, the objective of the current study is to systematically rate factors of non-adherence that have been reported in past research studies. Methods Grounded Theory, recognized as a rigorous method that facilitates the emergence of new themes through systematic analysis, data collection and coding, was used to analyze quantitative, qualitative and mixed method studies addressing the following autoimmune diseases: Rheumatoid Arthritis, gout, Crohn’s Disease, Systematic Lupus Erythematosus, and inflammatory bowel disease. Studies were only included if they contained primary data addressing the relationship with non-adherence. Results Out of the 27 studies, four non-modifiable and 11 modifiable risk factors were discovered. Over one third of articles identified the following risk factors as common contributors to medication non-adherence (percent of studies reporting): patients not understanding treatment (44%), side effects (41%), age (37%), dose regimen (33%), and perceived medication ineffectiveness (33%). An unanticipated finding that emerged was the need for risk stratification tools (81%) with patient-centric approaches (67%). Conclusions This study systematically identifies and categorizes medication non-adherence risk factors in select autoimmune diseases. Findings indicate that patients understanding of their disease and the role of medication are paramount. An unexpected finding was that the majority of research articles called for the creation of tailored, patient-centric interventions that dispel personal misconceptions about disease, pharmacotherapy, and how the body responds to treatment. To our knowledge, these interventions do not yet exist in digital format. Rather than adopting a systems level approach, digital health programs should focus on cohorts with heterogeneous needs, and develop tailored interventions based on individual non-adherence patterns.
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Affiliation(s)
- Trevor van Mierlo
- Evolution Health Systems Inc., 1266 Queen Street West, Suite 8, Toronto, Ontario, M6K 1L3, Canada
- Research Associate, Henley Business School, University of Reading, Greenlands, Henley-on-Thames, Oxfordshire, RG9 3AU, United Kingdom
- * E-mail:
| | - Rachel Fournier
- Evolution Health Systems Inc., 1266 Queen Street West, Suite 8, Toronto, Ontario, M6K 1L3, Canada
- Research Associate, Henley Business School, University of Reading, Greenlands, Henley-on-Thames, Oxfordshire, RG9 3AU, United Kingdom
| | - Michael Ingham
- Janssen Scientific Affairs LLC, 850 Ridgeview Dr., Horsham, Pennsylvania, 19044, United States of America
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Adherence to Oral and Topical Medications in Cutaneous Lupus Erythematosus is not Well Characterized. Dermatol Ther (Heidelb) 2015; 5:91-105. [PMID: 25899142 PMCID: PMC4470959 DOI: 10.1007/s13555-015-0075-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Treatment adherence plays a large role in chronic dermatologic diseases and may play an important role in the outcomes of patients with cutaneous lupus erythematosus (CLE). We sought to gauge what is currently known about adherence to topical and oral medications in patients with CLE. METHODS A review of MEDLINE was performed using a combination of the phrases "adherence", "compliance", "lupus", and "cutaneous". Studies were hand searched and prospective and cross-sectional studies evaluating medication adherence in patients with CLE and systemic lupus erythematosus (SLE) were included. RESULTS Only two articles explored adherence in patients with CLE, while 17 articles discussed treatment adherence in patients with SLE. Depression was consistently cited as detrimental to adherence. The impact that race, ethnicity, and education has on adherence is unclear. Three studies noted a clear connection between adherence and disease activity, while two others did not. Few studies investigated methods that have improved adherence to treatment which have showed promise. CONCLUSION Much of what we know about adherence to medication in patients with lupus is limited to SLE. Although cutaneous symptoms are among the most common manifestations of SLE, cutaneous disease is often managed at least in part with topical agents, and adherence to topical treatment was not assessed in any of the articles, though one study investigated sunscreen usage in patients with CLE. Understanding adherence in patients with CLE may help contribute to better CLE treatment outcomes.
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Galo JS, Mehat P, Rai SK, Avina-Zubieta A, De Vera MA. What are the effects of medication adherence interventions in rheumatic diseases: a systematic review. Ann Rheum Dis 2015; 75:667-73. [PMID: 25667208 DOI: 10.1136/annrheumdis-2014-206593] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/15/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Consistent reports of suboptimal treatment adherence among patients with inflammatory arthritis underscore the importance of understanding how adherence can be promoted and supported. Our objectives were to identify and classify adherence interventions; and assess the evidence on the effects of adherence interventions on outcomes of patients with rheumatic diseases. METHODS We conducted a mapped search of Medline, Embase and International Pharmaceutical Abstract databases to identify studies meeting inclusion criteria of: (1) patient population with inflammatory arthritis; (2) evaluation of an intervention or programme targeting medication adherence directly or indirectly; (3) reporting of one or more measures of medication adherence and disease outcome; (4) publication in English, French or Spanish. For our first objective, we applied a structured framework to classify interventions according target (patient vs provider), focus (educational vs behavioural vs affective), implementation (generalised vs tailored), complexity (single vs multifaceted) and provider. For the second objective, we appraised the evidence of effects of interventions on adherence and disease outcomes. RESULTS We identified 23 studies reporting adherence interventions that directly or indirectly addressed treatment adherence in rheumatic diseases and further appraised included RCTs. Interventions that were shown to impact adherence outcomes were generally interventions directed at adherence, tailored to patients and delivered by a healthcare provider. For interventions that were not shown to have impacts, reasons may be those related to the intervention itself, patient characteristics or study methodology. CONCLUSIONS Our systematic review shows limited research on adherence interventions in rheumatic diseases with inconsistent impacts on adherence or disease outcome.
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Affiliation(s)
- Jessica S Galo
- University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada
| | - Pavandeep Mehat
- University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Sharan K Rai
- Arthritis Research Canada, Richmond, British Columbia, Canada Department of Experimental Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Antonio Avina-Zubieta
- Arthritis Research Canada, Richmond, British Columbia, Canada Department of Experimental Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada Division of Rheumatology, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Mary A De Vera
- University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada Arthritis Research Canada, Richmond, British Columbia, Canada
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Burudpakdee C, Khan ZM, Gala S, Nanavaty M, Kaura S. Impact of patient programs on adherence and persistence in inflammatory and immunologic diseases: a meta-analysis. Patient Prefer Adherence 2015; 9:435-48. [PMID: 25792817 PMCID: PMC4364594 DOI: 10.2147/ppa.s77053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Patient adherence and persistence is important to improve outcomes in chronic conditions, including inflammatory and immunologic (I&I) diseases. Patient programs that aim at improving medication adherence or persistence play an essential role in optimizing care. This meta-analysis assessed the effectiveness of patient programs in the therapeutic area of I&I diseases. METHODS A global systematic literature review was conducted with inclusion criteria of: patient programs in I&I diseases; published in English language between January 2008 and September 2013; and reporting measures of adherence or persistence, including medication possession ratio >80% and persistence rate. A meta-analysis was performed using a random effects model. Subgroup analyses based on the type of program was performed whenever feasible. RESULTS Of 67 studies reviewed for eligibility, a total of 17 studies qualified for inclusion in the meta-analysis. Overall, patient programs increased adherence (odds ratio [OR]=2.48, 95% confidence interval [CI]=1.68-3.64, P<0.00001) as compared with standard of care. Combination patient programs that used both informational and behavioral strategies were superior in improving adherence (OR=3.68, 95% CI=2.20-6.16, P<0.00001) compared with programs that used only informational (OR=2.16, 95% CI=1.36-3.44, P=0.001) or only behavioral approaches (OR=1.85, 95% CI=1.00-3.45, P=0.05). Additionally, patients were more likely to be persistent (OR=2.26, 95% CI=1.16-4.39, P=0.02) in the intervention group as compared with the control group. Persistence (in days) was significantly (P=0.007) longer, by 42 additional days, in the intervention group than in the control group. CONCLUSIONS Patient programs can significantly improve adherence as well as persistence in the therapeutic area of I&I diseases. Programs employing a multimodal approach are more effective in improving adherence than programs with informational or behavioral strategies alone. This in turn may improve patient outcomes.
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Affiliation(s)
- Chakkarin Burudpakdee
- Market Access Solutions, LLC, Raritan, NJ, USA
- University of North Carolina at Charlotte, Charlotte, NC, USA
- Correspondence: Chakkarin Burudpakdee, IMS Health, 8280 Willow Oaks Corporate Drive, STE 775 Fairfax, VA 22031, USA, Tel +1 703 992 1028, Email
| | | | - Smeet Gala
- Market Access Solutions, LLC, Raritan, NJ, USA
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Nieuwlaat R, Wilczynski N, Navarro T, Hobson N, Jeffery R, Keepanasseril A, Agoritsas T, Mistry N, Iorio A, Jack S, Sivaramalingam B, Iserman E, Mustafa RA, Jedraszewski D, Cotoi C, Haynes RB. Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2014; 2014:CD000011. [PMID: 25412402 PMCID: PMC7263418 DOI: 10.1002/14651858.cd000011.pub4] [Citation(s) in RCA: 671] [Impact Index Per Article: 67.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND People who are prescribed self administered medications typically take only about half their prescribed doses. Efforts to assist patients with adherence to medications might improve the benefits of prescribed medications. OBJECTIVES The primary objective of this review is to assess the effects of interventions intended to enhance patient adherence to prescribed medications for medical conditions, on both medication adherence and clinical outcomes. SEARCH METHODS We updated searches of The Cochrane Library, including CENTRAL (via http://onlinelibrary.wiley.com/cochranelibrary/search/), MEDLINE, EMBASE, PsycINFO (all via Ovid), CINAHL (via EBSCO), and Sociological Abstracts (via ProQuest) on 11 January 2013 with no language restriction. We also reviewed bibliographies in articles on patient adherence, and contacted authors of relevant original and review articles. SELECTION CRITERIA We included unconfounded RCTs of interventions to improve adherence with prescribed medications, measuring both medication adherence and clinical outcome, with at least 80% follow-up of each group studied and, for long-term treatments, at least six months follow-up for studies with positive findings at earlier time points. DATA COLLECTION AND ANALYSIS Two review authors independently extracted all data and a third author resolved disagreements. The studies differed widely according to medical condition, patient population, intervention, measures of adherence, and clinical outcomes. Pooling results according to one of these characteristics still leaves highly heterogeneous groups, and we could not justify meta-analysis. Instead, we conducted a qualitative analysis with a focus on the RCTs with the lowest risk of bias for study design and the primary clinical outcome. MAIN RESULTS The present update included 109 new RCTs published since the previous update in January 2007, bringing the total number of RCTs to 182; we found five RCTs from the previous update to be ineligible and excluded them. Studies were heterogeneous for patients, medical problems, treatment regimens, adherence interventions, and adherence and clinical outcome measurements, and most had high risk of bias. The main changes in comparison with the previous update include that we now: 1) report a lack of convincing evidence also specifically among the studies with the lowest risk of bias; 2) do not try to classify studies according to intervention type any more, due to the large heterogeneity; 3) make our database available for collaboration on sub-analyses, in acknowledgement of the need to make collective advancement in this difficult field of research. Of all 182 RCTs, 17 had the lowest risk of bias for study design features and their primary clinical outcome, 11 from the present update and six from the previous update. The RCTs at lowest risk of bias generally involved complex interventions with multiple components, trying to overcome barriers to adherence by means of tailored ongoing support from allied health professionals such as pharmacists, who often delivered intense education, counseling (including motivational interviewing or cognitive behavioral therapy by professionals) or daily treatment support (or both), and sometimes additional support from family or peers. Only five of these RCTs reported improvements in both adherence and clinical outcomes, and no common intervention characteristics were apparent. Even the most effective interventions did not lead to large improvements in adherence or clinical outcomes. AUTHORS' CONCLUSIONS Across the body of evidence, effects were inconsistent from study to study, and only a minority of lowest risk of bias RCTs improved both adherence and clinical outcomes. Current methods of improving medication adherence for chronic health problems are mostly complex and not very effective, so that the full benefits of treatment cannot be realized. The research in this field needs advances, including improved design of feasible long-term interventions, objective adherence measures, and sufficient study power to detect improvements in patient-important clinical outcomes. By making our comprehensive database available for sharing we hope to contribute to achieving these advances.
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Affiliation(s)
- Robby Nieuwlaat
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Nancy Wilczynski
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Tamara Navarro
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Nicholas Hobson
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Rebecca Jeffery
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Arun Keepanasseril
- McMaster UniversityDepartments of Clinical Epidemiology & Biostatistics, and Medicine, Faculty of Health Sciences1280 Main Street WestHamiltonONCanadaL8S 4L8
| | - Thomas Agoritsas
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Niraj Mistry
- St. Michael's HospitalDepartment of Pediatrics30 Bond StreetTorontoONCanadaM5B 1W8
| | - Alfonso Iorio
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Susan Jack
- McMaster UniversitySchool of Nursing, Faculty of Health SciencesHealth Sciences CentreRoom 2J32, 1280 Main Street WestHamiltonONCanadaL8S 4K1
| | | | - Emma Iserman
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Reem A Mustafa
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Dawn Jedraszewski
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - Chris Cotoi
- McMaster UniversityDepartment of Clinical Epidemiology and BiostatisticsHamilton General Hospital campus, Room C3‐107237 Barton Street EastHamiltonONCanadaL8L 2X2
| | - R. Brian Haynes
- McMaster UniversityDepartments of Clinical Epidemiology & Biostatistics, and Medicine, Faculty of Health Sciences1280 Main Street WestHamiltonONCanadaL8S 4L8
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Kannisto KA, Koivunen MH, Välimäki MA. Use of mobile phone text message reminders in health care services: a narrative literature review. J Med Internet Res 2014; 16:e222. [PMID: 25326646 PMCID: PMC4211035 DOI: 10.2196/jmir.3442] [Citation(s) in RCA: 183] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/30/2014] [Accepted: 08/25/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mobile text messages are a widely recognized communication method in societies, as the global penetration of the technology approaches 100% worldwide. Systematic knowledge is still lacking on how the mobile telephone text messaging (short message service, SMS) has been used in health care services. OBJECTIVE This study aims to review the literature on the use of mobile phone text message reminders in health care. METHODS We conducted a systematic literature review of studies on mobile telephone text message reminders. The data sources used were PubMed (MEDLINE), CINAHL, Proquest Databases/ PsycINFO, EMBASE, Cochrane Library, Scopus, and hand searching since 2003. Studies reporting the use of SMS intended to remind patients in health services were included. Given the heterogeneity in the studies, descriptive characteristics, purpose of the study, response rates, description of the intervention, dose and timing, instruments, outcome measures, and outcome data from the studies were synthesized using a narrative approach. RESULTS From 911 initial citations, 60 studies were included in the review. The studies reported a variety of use for SMS. Mobile telephone text message reminders were used as the only intervention in 73% (44/60) of the studies, and in 27% (16/60) of the remaining studies, SMS was connected to another comprehensive health intervention system. SMS reminders were sent to different patient groups: patients with HIV/AIDS (15%, 9/60) and diabetes (13%, 8/60) being the most common groups. The response rates of the studies varied from 22-100%. Typically, the text message reminders were sent daily. The time before the specific intervention to be rendered varied from 10 minutes (eg, medication taken) to 2 weeks (eg, scheduled appointment). A wide range of different evaluation methods and outcomes were used to assess the impact of SMS varying from existing databases (eg, attendance rate based on medical records), questionnaires, and physiological measures. About three quarters of the studies (77%, 46/60) reported improved outcomes: adherence to medication or to treatment reportedly improved in 40% (24/60) of the studies, appointment attendance in 18% (11/60) of the studies, and non-attendance rates decreased in 18% (11/60) of the studies. Other positive impacts were decreased amount of missed medication doses, more positive attitudes towards medication, and reductions in treatment interruptions. CONCLUSIONS We can conclude that although SMS reminders are used with different patient groups in health care, SMS is less systematically studied with randomized controlled trial study design. Although the amount of evidence for SMS application recommendations is still limited, having 77% (46/60) of the studies showing improved outcomes may indicate its use in health care settings. However, more well-conducted SMS studies are still needed.
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Tazi Mezalek Z, Bono W. Challenges for lupus management in emerging countries. Presse Med 2014; 43:e209-20. [PMID: 24857588 DOI: 10.1016/j.lpm.2014.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/03/2014] [Indexed: 12/23/2022] Open
Abstract
In emerging countries, systemic lupus erythematosus (SLE) has been associated with several unfavorable outcomes including disease activity, damage accrual, work disability and mortality. Poor socioeconomic status (SES) and lack of access to healthcare, especially in medically underserved communities, may be responsible for many of the observed disparities. Diagnostic delay of SLE or for severe organ damages (renal involvement) have a negative impact on those adverse outcomes in lupus patients who either belong to minority groups or live in emerging countries. Longitudinal and observational prospective studies and registries may help to identify the factors that influence poor SLE outcomes in emerging countries. Infection is an important cause of mortality and morbidity in SLE, particularly in low SES patients and tuberculosis appears to be frequent in SLE patients living in endemic areas (mainly emerging countries). Thus, tuberculosis screening should be systematically performed and prophylaxis discussed for patients from these areas. SLE treatment in the developing world is restricted by the availability and cost of some immunosuppressive drugs. Moreover, poor adherence has been associated to bad outcomes in lupus patients with a higher risk of flares, morbidity, hospitalization, and poor renal prognosis. Low education and the lack of money are identified as the main barrier to improve lupus prognosis. Newer therapeutic agents and new protocols had contributed to improve survival in SLE. The use of corticoid-sparing agents (hydroxychloroquine, methotrexate, azathioprine and mycophenolate mofetif) is one of the most useful strategy; availability of inexpensive generics may help to optimize access to these medications.
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Affiliation(s)
- Zoubida Tazi Mezalek
- Université Mohamed V Souissi, Faculté de médecine et de pharmacie, 10000 Rabat, Morocco; Ibn Sina University Hospital, internal medicine department, 10000 Rabat, Morocco.
| | - Wafaa Bono
- Hassan II University Hospital, internal medicine and immunology Clinic, Fès, Morocco
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Costedoat-Chalumeau N, Dunogué B, Morel N, Le Guern V, Guettrot-Imbert G. Hydroxychloroquine: a multifaceted treatment in lupus. Presse Med 2014; 43:e167-80. [PMID: 24855048 DOI: 10.1016/j.lpm.2014.03.007] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 03/18/2014] [Indexed: 12/13/2022] Open
Abstract
The efficacy of antimalarials, especially hydroxychloroquine (HCQ), in preventing systemic lupus erythematosus (SLE) flares is well demonstrated. However, many studies show that the percentage of SLE patients treated with HCQ remains low. By blocking the toll-like receptor 7 and 9 in plasmacytoid dendritic cells, HCQ inhibits interferon-alpha production which plays a crucial role in SLE pathogenesis. In addition to reducing damage accrual in SLE patients, HCQ appears to protect against the occurrence of diabetes, thrombotic events, and dyslipidemia. As a consequence, some studies have suggested that HCQ, which is inexpensive, has a protective effect on survival in SLE patients. Thanks to the pharmacokinetic properties of HCQ (long half-life) and to the availability of its blood assay, very low or undetectable blood HCQ concentrations are a valuable marker of non-adherence to treatment, thus adding a new benefit to HCQ prescriptions. The main side effect of HCQ is retinal toxicity. This complication is very rare, but may be potentially severe, thus requiring regular screening. Retinal toxicity remains the only absolute contra-indication of HCQ in adult SLE patients. Other contra-indications are few and rare. During pregnancy and breast-feeding, HCQ continuation is not only allowed but recommended. In conclusion, the risk/benefit ratio of HCQ is excellent. Many now believe that all SLE patients should be offered this treatment.
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Affiliation(s)
- Nathalie Costedoat-Chalumeau
- AP-HP, université René-Descartes Paris V, hôpital Cochin, centre de référence maladies auto-immunes et systémiques rares, pôle médecine, service de médecine interne, 75679 Paris cedex 14, France.
| | - Bertrand Dunogué
- AP-HP, université René-Descartes Paris V, hôpital Cochin, centre de référence maladies auto-immunes et systémiques rares, pôle médecine, service de médecine interne, 75679 Paris cedex 14, France
| | - Nathalie Morel
- AP-HP, université René-Descartes Paris V, hôpital Cochin, centre de référence maladies auto-immunes et systémiques rares, pôle médecine, service de médecine interne, 75679 Paris cedex 14, France
| | - Véronique Le Guern
- AP-HP, université René-Descartes Paris V, hôpital Cochin, centre de référence maladies auto-immunes et systémiques rares, pôle médecine, service de médecine interne, 75679 Paris cedex 14, France
| | - Gaëlle Guettrot-Imbert
- Université de Clermont-Ferrand, CHU de Clermont-Ferrand, hôpital Gabriel-Montpied, service de médecine interne, 63003 Clermont-Ferrand, France
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Costedoat-Chalumeau N, Le Guern V, Piette JC. Determining adherence to therapeutic regimens in patients with chronic illness: comment on the article by Waimann et Al. Arthritis Rheumatol 2014; 66:770. [PMID: 24574241 DOI: 10.1002/art.38243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Park LG, Howie-Esquivel J, Dracup K. A quantitative systematic review of the efficacy of mobile phone interventions to improve medication adherence. J Adv Nurs 2014; 70:1932-1953. [PMID: 24689978 DOI: 10.1111/jan.12400] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2014] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate the characteristics and efficacy of mobile phone interventions to improve medication adherence. Secondary aims are to explore participants' acceptability and satisfaction with mobile phone interventions and to evaluate the selected studies in terms of study rigour, impact, cost and resource feasibility, generalizability and implications for nursing practice and research. BACKGROUND Medication non-adherence is a major global challenge. Mobile phones are the most commonly used form of technology worldwide and have the potential to promote medication adherence. DESIGN Guidelines from the Centre for Reviews and Dissemination were followed for this systematic review. DATA SOURCES A comprehensive search of databases (PubMed, Web of Science, CINAHL, PsycInfo, Google Chrome and Cochrane) and bibliographies from related articles was performed from January 2002-January 2013 to identify the included studies. REVIEW METHODS A quantitative systematic review without meta-analysis was conducted and the selected studies were critically evaluated to extract and summarize pertinent characteristics and outcomes. RESULTS The literature search produced 29 quantitative research studies related to mobile phones and medication adherence. The studies were conducted for prevention purposes as well as management of acute and chronic illnesses. All of the studies used text messaging. Eighteen studies found significant improvement in medication adherence. CONCLUSION While the majority of investigators found improvement in medication adherence, long-term studies characterized by rigorous research methodologies, appropriate statistical and economic analyses and the test of theory-based interventions are needed to determine the efficacy of mobile phones to influence medication adherence.
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Affiliation(s)
- Linda G Park
- Division of Geriatrics, University of California, San Francisco VA Medical Center, California, USA
| | | | - Kathleen Dracup
- School of Nursing, University of California, San Francisco, California, USA
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Rivera F, Anaya S. Lupus nephritis flare in young patients: relapse or nonadherence to treatment? Int J Nephrol Renovasc Dis 2014; 7:117-21. [PMID: 24729723 PMCID: PMC3974696 DOI: 10.2147/ijnrd.s58206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose Adherence is a challenging issue in the treatment of systemic lupus erythematosus. Nonadherence has been widely addressed in patients with lupus and must be detected quickly to prevent severe complications. The cases we present illustrate the importance of adherence in young adults. Case 1 A 23-year-old Spanish woman diagnosed with severe lupus nephritis 8 years previously achieved renal remission after immunosuppressive treatment with corticosteroids and cyclophosphamide. Three years later, she developed a renal flare. Her treatment was intensified, and rituximab and mycophenolate mofetil were added. One year later, she was readmitted for a new renal flare. A blood test revealed no detectable levels of mycophenolic acid, and the patient admitted she had not taken her treatment correctly. Treatment was resumed. Four years later, the patient remains in remission. Case 2 A 19-year-old Spanish woman was diagnosed with nephrotic syndrome due to lupus nephritis. She achieved complete remission after treatment with corticosteroids and cyclophosphamide followed by mycophenolate mofetil. Two years later, she developed a severe renal relapse that was treated with corticosteroids, cyclophosphamide, and rituximab. The response to treatment was good. Mycophenolic acid was undetectable in blood. The patient admitted that she had often missed doses before this relapse. The renal response has been maintained since she resumed her previous medications 2 years ago. Conclusion We conclude that the frequent and severe relapses of lupus nephritis observed in young patients may actually be due to nonadherence rather than to refractory disease. Our cases are typical examples of nonadherence that were discovered after a detailed interview with the patients and their families. We emphasize the need for clinical suspicion of nonadherence when caring for young adults with lupus.
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Affiliation(s)
- Francisco Rivera
- Sección de Nefrología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Sara Anaya
- Sección de Nefrología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
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Lehman TJA, Singh C, Ramanathan A, Alperin R, Adams A, Barinstein L, Moorthy N. Prolonged improvement of childhood onset systemic lupus erythematosus following systematic administration of rituximab and cyclophosphamide. Pediatr Rheumatol Online J 2014; 12:3. [PMID: 24423147 PMCID: PMC3896732 DOI: 10.1186/1546-0096-12-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 01/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the combination of cyclophosphamide and rituximab has been utilized in case reports, there are no previous reports of the long term outcome of SLE treated systematically with this regimen. We report a pilot study to evaluate the efficacy of a systematically administered course of rituximab and cyclophosphamide over an eighteen month period to provide sustained improvement in childhood onset systemic lupus erythematosus (SLE). FINDINGS Twelve patients with childhood onset lupus nephritis or corticosteroid resistant SLE received systematic treatment with a combination of rituximab (750 mg/M2 up to 1 gram) and cyclophosphamide (750 mg/M2: no patient exceeded 1.8 M2). Two administrations of rituximab and cyclophosphamide, two weeks apart, were administered at the start of study, six months later, and eighteen months later. Clinical data were collected and analyzed after sixty months of follow up. There was sustained improvement in all clinical parameters with a dramatic reduction in both mean SLEDAI score (10.1 to 1 at one year and 0 at five years p<0.005) and mean daily prednisone dosage (29.7 mg/day to 12.7 by one year and 7.0 mg/day at five years p<0.005), with sustained improvement in mean C3 (55.5 mg/ml to 113 at one year and 107.5 at five years p<0.001) which was maintained through sixty months of follow up. Serum immunoglobulin levels were transiently depressed but mean values were within the normal range for both IgG and IgM at one and five years. Few complications were observed (two episodes of febrile neutropenia during the first year of treatment were the only serious adverse events) and patients routinely reported sustained wellbeing. CONCLUSIONS This pilot study demonstrates that a systematically administered course of rituximab and cyclophosphamide over an eighteen month period provided sustained relief for patients with childhood onset SLE which was maintained over a sixty month period, while minimizing the need for corticosteroids, without excessive toxicity.
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Affiliation(s)
- Thomas JA Lehman
- Hospital for Special Surgery, Weil Cornell Medical College, New York, NY, USA
| | - Chahait Singh
- Hospital for Special Surgery, Weil Cornell Medical College, New York, NY, USA
| | - Anusha Ramanathan
- Hospital for Special Surgery, Weil Cornell Medical College, New York, NY, USA
| | - Risa Alperin
- Hospital for Special Surgery, Weil Cornell Medical College, New York, NY, USA
| | - Alexa Adams
- Hospital for Special Surgery, Weil Cornell Medical College, New York, NY, USA
| | - Laura Barinstein
- Hospital for Special Surgery, Weil Cornell Medical College, New York, NY, USA
| | - Nandini Moorthy
- Rutgers University, Robert Wood Johnson Medical School, New Brunswick, New Brunswick, NJ, USA
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Whisenhunt A. Social work and medical care: electronic reminders to address adherence. JOURNAL OF EVIDENCE-BASED SOCIAL WORK 2014; 11:248-255. [PMID: 24857553 DOI: 10.1080/15433714.2012.759460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Social workers are often involved with patients and families around adherence, both to clinic appointments as well as to the medication regimen. An evidence-based practice project was created and implemented to determine the efficacy of electronic reminders such as text messaging on adherence. The implications of improving adherence can positively impact the patient on an individual level as well as reduce costs and increase revenue at a systems level.
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Building patient relationships: a smartphone application supporting communication between teenagers with asthma and the RN care coordinator. Comput Inform Nurs 2013; 31:266-71; quiz 272-3. [PMID: 23728445 DOI: 10.1097/nxn.0b013e318295e5ba] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Smartphone applications used in healthcare are emerging as an adjunct therapy to assist patients in self-management. Often, smartphone technology is not integrated into healthcare delivery and does not build the nurse-patient relationship, an essential mechanism to guide the patient toward health. In a pilot study using smartphones with teenagers with asthma, the application provided a method not only to share health information at the point-of-living, including health assessments, personalized health plans, and disease information, but also to allow text messaging communication between the teenager and his/her RN care coordinator. Twenty-five teenagers piloted the smartphone application and provided feedback about its use. Eighty-five percent of the teenagers responding to the end-of-pilot, semistructured interview indicated a positive change in the nurse-patient relationship. Teenagers perceived that they could ask more questions along with having improved access and quicker response times. The RN care coordinators perceived improved ability to contact teenagers and improved accuracy of assessment data. Although the pilot had several limitations, it demonstrates that smartphone technology and text messaging can further the nurse-patient relationship. For this to occur, nurses need to become involved in the development and integration of technology to focus applications on innovative ways to enhance communication in patient care.
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Abstract
Children and families often have difficulty following prescribed medical treatment for chronic pediatric conditions. Such nonadherence has a significant impact on children's health care outcomes and the costs of their care. This review describes a comprehensive approach to increase treatment adherence in chronic pediatric illnesses and lessen its impact. Key elements of this proposed model of adherence promotion include the following: (1) a core approach to adherence promotion to be implemented by pediatric health care providers; (2) follow-up and ongoing management; and (3) tailoring and targeting specific more intensive family-centered interventions to children and adolescents who demonstrate clinically significant treatment nonadherence or risk for nonadherence. Behavioral specialists have important roles in conducting research on adherence promotion, training health care providers, and delivering services to children and adolescents with clinically significant adherence problems.
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Costedoat-Chalumeau N, Galicier L, Aumaître O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Boutin DLTH, Asli B, Kahn JE, Pourrat J, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Jallouli M, Leroux G, Cohen-Bittan J, Tanguy ML, Hulot JS, Lechat P, Musset L, Amoura Z, Piette JC. Hydroxychloroquine in systemic lupus erythematosus: results of a French multicentre controlled trial (PLUS Study). Ann Rheum Dis 2012; 72:1786-92. [DOI: 10.1136/annrheumdis-2012-202322] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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