Polypharmacy in Adults with Systemic Lupus Erythematosus

Abstract

Background: Estimates of polypharmacy among U.S. adults with systemic lupus erythematosus (SLE) - a relatively young and disproportionately minoritized population - remain sparse. We sought to estimate the prevalence of polypharmacy in SLE and identify the most common medications used.

Methods: For this cross-sectional study, participants were recruited from a population-based cohort of adults with validated SLE in Atlanta, Georgia. Prescription and over-the-counter (OTC) medications were self-reported at the study visit. Polypharmacy was defined as ≥5 prescription or OTC medications. Estimates of polypharmacy prevalence by key sociodemographic and SLE-related participant characteristics were obtained using crude logistic regression and post-estimation marginals.

Results: More than half (56.3%) of participants (N=451; 15.3% ≥60 years old, 91.8% female, and 81.8% Black) reported polypharmacy. Older age (68.1%, 59.8%, and 43.0% for ages ≥60, 40-59, and 18-39), higher vs. lower disease activity (65.8% vs. 46.2%) and cumulative SLE-related damage (68.5% vs. 42.4%), longer disease duration (62.4% vs. 50.0%), and taking 3-5 vs. 0-1 immunomodulating medications (79.6% vs. 38.0%) were associated with higher age-adjusted prevalence of polypharmacy; prevalence was not statistically significantly different by sex, race, or education. While hydroxychloroquine (71.4%), glucocorticoids (44.3%), and other immunomodulating drugs (50.3%) were common, polypharmacy was most often driven by other medications, such as anti-hypertensives (61.9%), non-opioid pain relievers (51.7%), allergy treatments (22.4%), antidepressants (22.2%), and gastric reflux medications (21.7%).

Conclusion: Our results underscore the need to address the burden of medication regimens in this population through individualized medication optimization strategies that account for prescription and OTC medications used by those with SLE.