Early Antimalarial Adherence Reduces Hospitalization in RA and SLE: Study

A study published in the journal of Arthritis & Rheumatology found that early adherence to antimalarial therapy, particularly hydroxychloroquine, in patients with newly diagnosed rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) may lower future hospitalizations and healthcare costs, emphasizing the importance of consistent medication use.

Early medication adherence is strongly advisable in managing chronic autoimmune diseases. Antimalarials known for their disease-modifying properties are commonly prescribed for RA and SLE. However, their effectiveness in real-world settings depends heavily on the consistency of their use.

This study examined provincial administrative health data from 1997 to 2022 which focused on individuals who were newly diagnosed with RA or SLE who had started antimalarial medications and were followed for at least a year. The patients were divided into two groups, where one group maintained high adherence to their medication regimen (medication coverage for at least 90% of days) and the other group who did not meet this threshold.

Using propensity score matching and pairing each adherent patient with up to two nonadherent counterparts who shared similar baseline characteristics, this study analyzed 8,768 adherent patients and 16,479 nonadherent patients.

The patients who adhered closely to their antimalarial therapy had an 11% lower rate of hospital admissions when compared to those who did not. They also spent 21% fewer days in the hospital over the following year. The economic impact in adherent patients was also significant, as it costed around CAD $549.64 less in hospitalization costs annually.

Through series of robustness checks, including falsification tests and sensitivity analyses this research ruled out alternative explanations like the healthy adherer effect, where patients who follow medication regimens may also engage in other health-promoting behaviors. Even after accounting for potential unmeasured confounders, the association between adherence and improved outcomes remained constant.

Overall, the findings of this study illuminate the crucial role of encouraging adherence early in the course of treatment may not only improve patient well-being but also reduce hospital utilization and associated costs. 

Source:

Hoque, M. R., Lacaille, D., Aviña-Zubieta, J. A., De Vera, M. A., Qian, Y., McCandless, L., Esdaile, J. M., & Xie, H. (2026a). Impact of early antimalarial adherence on future acute care utilization and cost among patients with rheumatoid arthritis and systemic lupus erythematosus: A population-based study. Arthritis & Rheumatology, art.70071. https://doi.org/10.1002/art.70071