A systematic literature review of psychosocial and behavioral factors associated with initial medication adherence: a report of the ISPOR medication adherence & persistence special interest group.

OBJECTIVES: Numerous factors influencing medication adherence in chronically ill patients are well documented, but the paucity of studies concerning initial treatment course experiences represents a significant knowledge gap. As interventions targeting this crucial first phase can affect long-term adherence and outcomes, an international panel conducted a systematic literature review targeting behavioral or psychosocial risk factors. METHODS: Eligible published articles presenting primary data from 1966 to 2011 were abstracted by independent reviewers through a validated quality instrument, documenting terminology, methodological approaches, and factors associated with initial adherence problems. RESULTS: We identified 865 potentially relevant publications; on full review, 24 met eligibility criteria. The mean Nichol quality score was 47.2 (range 19-74), with excellent reviewer concordance (0.966, P < 0.01). The most prevalent pharmacotherapy terminology was initial, primary, or first-fill adherence. Articles described the following factors commonly associated with initial nonadherence: patient characteristics (n = 16), medication class (n = 12), physical comorbidities (n = 12), pharmacy co-payments or medication costs (n = 12), health beliefs and provider communication (n = 5), and other issues. Few studies reported health system factors, such as pharmacy information, prescribing provider licensure, or nonpatient dynamics. CONCLUSIONS: Several methodological challenges synthesizing the findings were observed. Despite implications for continued medication adherence and clinical outcomes, relatively few articles directly examined issues associated with initial adherence. Notwithstanding this lack of information, many observed factors associated with nonadherence are amenable to potential interventions, establishing a solid foundation for appropriate ongoing behaviors. Besides clarifying definitions and methodology, future research should continue investigating initial prescriptions, treatment barriers, and organizational efforts to promote better long-term adherence.

Multi-center evaluation of autoantibodies to the major ribosomal P C22 epitope.

Anti-ribosomal P (Rib-P) autoantibodies have been demonstrated to be a specific diagnostic marker for systemic lupus erythematosus (SLE). The aim of this study was to evaluate the prevalence of anti-Rib-P (C22) antibodies in patients with SLE drawn from international, multi-center clinics. Sera collected from patients with SLE (n = 333) and various controls (n = 397) in four centers were tested for anti-C22 autoantibodies by ELISA (Dr. Fooke Laboratorien). SLE activity index 2000 (SLEDAI-2K) was assessed for each patient in two centers. Autoantibody profiles were generated for the SLE samples from Canada using two profile assays. Using the manufacturer`s cut-off value, the prevalence of anti-C22 autoantibodies in patients with SLE between the participating centers varied from 18.2 to 29.0%. In the control sera, the prevalence of anti-C22 autoantibodies was low and the titer in the individual control groups varied significantly. In patients with connective tissue disease other than SLE and in patients with infections disease, the anti-C22 reactivity was significantly higher than in healthy controls (P < 0.0001). Overall sensitivity/specificity was 23.1/99.0%, respectively. Anti-Rib-P reactivity was significantly higher in young (mean age 33.9 vs. 45.3 years) SLE patients (P < 0.0001) and was associated with decreased C3 (P = 0.0335) and C4 levels (P = 0.0129). Moderate association between anti-C22 reactivity and SLEDAI-2K was observed in one cohort (P = 0.02). Anti-C22 autoantibodies are frequently and specifically found in patients with SLE. Although an association between anti-C22 reactivity and SLEDAI score was observed in one center, measurement of anti-C22 autoantibodies is likely not appropriate for measuring global disease activity.