Barriers to therapy adherence in a group of Italian patients with systemic lupus erythematosus

Objective The aim of this cross-sectional study was to investigate the prevalence and associated barriers of non-adherence to therapy (NAT) in a large cohort of Italian patients with systemic lupus erythematosus (SLE). Methods This multicentre cross-sectional study included 432 adult SLE patients. Adherence to therapy (AT) was assessed through the Medication Adherence Self-Report Inventory (MASRI) and adherence rates <80% were considered non-adherent. Psychological distress was evaluated via the Hospital Anxiety and Depression Scale (HADS). Barriers to AT were identified using a 32-item questionnaire addressing patient-, therapy-, socioeconomic-, and healthcare-related factors. Statistical analyses were performed to identify associations with NAT. Results NAT was observed in 38% of patients and was significantly associated with younger age (p<0.001) and higher HADS scores (p<0.001). Common patient-related barriers included forgetfulness (OR=11.56, p<0.001), daily routine changes (OR=5.29, p<0.001), and perceived hassle (OR=4.85, p<0.001). Key therapy-related barriers included fear (OR=29.15, p<0.001) and suffering (OR=5.73, p<0.001) side effects. Among socioeconomic barriers, only cost concerns were associated with NAT (OR=3.75, p=0.002). Healthcare system-related issues such as long waiting list (OR=2.01, p=0.003), divergent medical opinions (OR=2.10, p=0.001), and prescribed delay (OR=2.36, p=0.004) were more frequent in NAT patients. ROC curve analysis revealed an association between age ≤48 years and the presence of NAT and related behavioural barriers. Conclusion NAT is prevalent among Italian SLE patients and is driven by a combination of modifiable patient, therapy, and healthcare system barriers. Younger patients are at high risk of NAT due to behavioural and psychosocial barriers. Age-targeted interventions are needed to enhance adherence and outcomes