Factors associated with medication adherence among patients with systemic lupus erythematosus: A systematic review

BackgroundSuboptimal medication adherence in systemic lupus erythematosus (SLE) significantly contributes to poor patient outcomes. However, a comprehensive synthesis of global evidence remains limited.ObjectiveTo systematically synthesize global evidence on factors influencing medication adherence in patients with SLE, categorize these determinants according to the World Health Organization's multidimensional framework, and develop a conceptual model of adherence.MethodsWe conducted a systematic review of studies published between 2000 and 2020 in PubMed, Scopus, and Web of Science, following PRISMA 2020 guidelines. Eligible studies included observational or qualitative research that examined factors related to adherence in patients with SLE. Of 362 records screened, 24 studies were included (N = 200,807). Because of heterogeneity in study design, populations, adherence measures, and reported effect sizes, a meta-analysis was not feasible. A narrative synthesis was performed, and effect measures were reported as presented in the original studies.ResultsStructural disadvantages emerged as major barriers to adherence. Patients with very low or low socioeconomic status (OR = 2.6, 95% CI: 1.6-4.3) and those living in rural areas (OR = 3.4, 95% CI: 1.4-5.0) were more likely to be non-adherent. Racial residential segregation was also associated with reduced access to healthcare resources and lower adherence rates (OR = 0.80, 95% CI: 0.67-0.96). These disadvantages were linked to impaired provider-patient communication (β = -0.41, p < .001), which in turn weakened trust in treatment (γ = 0.68). Trust in treatment functioned as a critical mediator of adherence (R² = 0.83). Clinically, poor adherence was associated with increased disease activity (HR = 2.11, 95% CI: 1.75-3.02) and greater psychological burden (OR = 5.7, 95% CI: 3.8-7.9). Cognitive decline also contributed, with each one-point decrease in MMSE scores linked to a 7.2% increase in missed doses.ConclusionMedication adherence in patients with SLE reflects the combined influence of structural inequalities and modifiable mediators. Socioeconomic disadvantage and segregation require systemic interventions, whereas provider-patient communication, treatment trust, and psychological support represent more immediate targets for action. Multilevel strategies are needed to address disparities and improve outcomes in SLE care.