Objective Medication non-concordance in systemic lupus erythematosus (SLE) is associated with a higher risk of flares, hospitalisations and mortality. Patient non-concordance involves a complex interplay of both patient and physician factors including communication, nature and severity of disease, treatment and the clinician-patient relationship. We hypothesise that patients starting medication initiated by a specialist nurse would have higher medication concordance.

Methods A retrospective analysis of patients attending the tertiary lupus clinic at King’s College Hospital was undertaken. Inclusion criteria included patients with a diagnosis of lupus being initiated on DMARD therapy (Mycophenolate, Methotrexate or Azathioprine) who had their medication prescribed and dispensed by the hospital pharmacy. Those starting biologics or receiving medication via Shared Care agreements were excluded. Patients were defined as concordant if they renewed all 3-monthly prescriptions over a 12 month period. Demographics, disease activity, employment status and ethnicity were recorded. We sought to assess differences in concordance between those initiated by Nurse Specialists versus doctors, and between those given written versus online information about the drug. Statistical analyses was performed using t-tests and Chi square.

Results 45 patients were included in the analysis. The results are summarized in table 1. The median age was 41.52 ± 12.04 years old with 86.9% females. 65% of patients were of black ethnicity, 56.5% of patients were employed and the median SLEDAI-2K score was 6 (6,8). 65% of patients were on Mycophenolate, 26% on Azathioprine and 6.5% on Methotrexate.

In total 64% (29/45) were concordant with medications over 12 months. 100% of patients initiated by a nurse were concordant for the full 12 months (28/28), compared to only 6% (1/17) initiated by a doctor. Concordance was significantly higher if patients were given an online link to an information leaflet compared to when a paper leaflet was provided.

Conclusions These findings suggest that patients with SLE who are initiated on DMARD therapy by a Nurse Specialist are markedly more likely to be concordant at 12 months when compared with those initiated by doctors, emphasising the vital role of Nurse Specialists in the care of patients with SLE.