AB1027 NEIGHBORHOOD DEPRIVATION SIGNIFICANTLY IMPACTS MEDICATION ADHERENCE IN SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: K. Brennan, A. Ramu, J. Allen, J. Shafik, N. Schwartz
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Social disparities, including neighborhood deprivation, in systemic lupus erythematosus (SLE) are known to play an important role in the disease's morbidity and mortality.<sup>1</sup> Nonadherence to long-term therapy like hydroxychloroquine (HCQ) is observed frequently in patients with SLE and is associated with poor outcomes, including higher likelihood of irreversible organ damage.<sup>2</sup> Studies have compared medication adherence between patients in rural and urban communities, and broad geographic swaths of the United States, but there is limited data regarding the impact of living in specific neighborhoods within the same urban environment on medication adherence amongst SLE patients. One tool to stratify disadvantage within the same geographic area is the Area Deprivation Index (ADI), a validated integrative tool that quantifies disadvantage on a neighborhood level.<sup>3,4</sup> <h3>Objectives:</h3> Examine the impact of living in a disadvantaged neighborhood on medication adherence, in a diverse cohort of patients with SLE in Bronx, New York, the poorest urban county in the United States. <h3>Methods:</h3> A retrospective analysis of 105 SLE patients at Montefiore Medical Center, Bronx, NY, who had HCQ serum levels measured between April and November 2023. Based on the patients' home addresses, their neighborhoods were categorized into state-specific deciles of the ADI, with higher numbers representing greater disadvantage. Non-parametric statistical analysis, including Fisher's Exact Test, and Kruskall-Wallis followed by Dunn's Multiple Comparison Tests were utilized, based on the comparison groups. Two-tailed <i>p-value</i> of &lt;0.05 was considered statistically significant. <h3>Results:</h3> Of 105 patients, 38% had therapeutic HCQ serum levels (&gt;1000 ng/ml), and even among those with optimal HCQ dosing (48 patients with HCQ dose of ≥5 mg/kg) only 46% had therapeutic levels. Race and ethnicity were similar among the therapeutic and non-therapeutic groups (<i>p</i>=0.62 and 0.41, respectively), and no association was observed between age and therapeutic levels of HCQ (<i>p</i>=0.42; Figure 1A-B). However, therapeutic HCQ levels were significantly associated with ADI deciles (<i>p</i>=0.03); with 100% of patients in the least disadvantaged areas having therapeutic levels and only 12.5% of those in the most disadvantaged areas (<i>p</i> = 0.01; Figure 1C-D). <h3>Conclusion:</h3> Overall, adherence to HCQ was low, even when accounting for dosing strategy. There was no relationship between race, ethnicity or age and HCQ levels. ADI was negatively associated with therapeutic serum HCQ levels, suggesting that interventions tailored to those patients living in more disadvantaged neighborhoods, even within the same geographical area, may lead to increased medication adherence and potentially improve outcomes. <h3>REFERENCES:</h3> [1] Buie J, McMillan E, Kirby J, <i>et al</i>. Disparities in lupus and the role of social determinants of health: current state of knowledge and directions for future research. <i>ACR Open Rheumatology</i>, 2023; 5:454-64. [2] Ruiz-Irastorza G, Ramos-Casals M, Brito-Zeron P, <i>et al</i>. Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus: a systematic review. <i>Annals of Rheumatic Diseases</i>, 2010; 69:20-28. [3] Kind AJH, Buckingham W. Making Neighborhood Disadvantage Metrics Accessible: The Neighborhood Atlas. <i>New England Journal of Medicine</i>, 2018; 378: 2456-2458 [4] University of Wisconsin School of Medicine and Public Health. 2024. Area Deprivation Index v2 <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Kiera Brennan: None declared, Anitha Ramu: None declared, Juliann Allen: None declared, Justina Shafik: None declared, Noa Schwartz Received a grant on behalf of the Montefiore Einstein Institute for Lupus Care and Research to support lupus patient support groups from Aurinia.