Adhering to Treatment Plan Linked to Higher Quality of Life in Sarcoidosis Patients
Sarcoidosis patients who more closely follow their established treatment plans were found to have a significantly improved health-related quality of life, a new observational study shows.
The study, “Association of Medication Adherence and Clinical Outcomes in Sarcoidosis,” which was published in the journal Chest, is the first to examine medication adherence among sarcoidosis patients, according to the researchers.
Continuous treatment plans are often necessary for sarcoidosis. However, research has shown that roughly half of patients do not strictly adhere to their prescribed plans.
One of the most frequently prescribed treatment options for sarcoidosis is glucocorticosteroids, as they can improve a patient’s lung function. Previous studies have shown that intermittent glucocorticosteroid usage is not as beneficial to patients as regular usage, so these medications are usually prescribed to be taken continuously.
In the study, researchers hypothesized that, by not adhering to continuous medication plans, sarcoidosis patients may be at risk for complications.
To investigate this hypothesis, a team collected data from 117 adult patients, median age of 57 years, at the Johns Hopkins Sarcoidosis Clinic from August 2018 to February 2019.
A majority of patients (47%) were prescribed both corticosteroids and steroid sparing agents, a class of medicines that aim to treat inflammation without the potential side effects of long-term steroid treatment. Among the remaining patients, 34% were prescribed only corticosteroids, and 19% were prescribed only steroid sparing agents.
How closely patients followed their treatment plans was measured by a self-evaluation test called the Medication Adherence Report Scale, which asks five questions that patients answer on a scale from 1 to 5, with higher scores associated with higher adherence to medication schedules.
Any score below 25 was considered to be non-adherence within this study. By those standards, 66% of the 117 patients reported some degree of non-adherence. The overall median score was 23.
Gender, income, education level, and disease severity (including disease duration and number of organs affected) did not show a significant correlation to non-adherence to treatment.
Race was the only factor with a significant correlation, as African-American patients were more likely to report non-adherence than white patients. Other races were not significantly represented and thus were not included in the analysis.
The researchers then investigated patient data for any connections between non-adherence and clinical outcomes. Clinical outcomes were assessed in three categories: health-related quality of life (HRQoL), lung functionality, and healthcare utilization.
HRQoL was scored using two established tests, the St. George Respiratory Questionnaire and King’s Sarcoidosis Questionnaire.
The researchers found that patients with higher scores on the adherence scale had higher quality of life scores on both tests.
However, no correlation was found between medication adherence and lung functionality or healthcare utilization.
Lung functionality was assessed based on several standardized measures, including the amount of air forced out of lungs in one second (forced expiratory volume or FEV1), amount of air forced out of lungs after a deep breath (forced vital capacity or FVC), and the rate of gas diffusion through the lungs (diffusion capacity of the lungs for carbon monoxide).
Healthcare utilization was assessed based on whether the patient had been hospitalized in the last 12 months or had visited the emergency room within the last six months.
Moreover, no association was found between medication regimen — corticosteroid only, steroid sparing agents only, or the combination of both — and medication adherence.
“This is the first study to investigate medication adherence in sarcoidosis, finding that higher medication adherence was associated with better HRQoL,” the researchers wrote.
They suggested that “medication adherence may be an important target to improve patient-reported outcomes and health disparities in sarcoidosis.”
However, future studies are needed to better understand the impact of medication adherence in clinical outcomes, they added.
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