Presentation (CTI)

OBJECTIVES: While advanced therapies have transformed the management of lupus nephritis (LN), their real-world clinical benefit relies heavily on sustained patient adherence, which remains under-characterized. Here we measure real-world adherence to, and persistence with, advanced therapies (belimumab and voclosporin) in patients with LN.
METHODS: The IQVIA PharMetrics Plus closed claims database was used to identify adult US patients diagnosed with LN between January 2021 and December 2023. Patients with ≥2 outpatient claims ≥30 days apart or ≥1 inpatient claim for LN (index), and a year of pre- and post-index continuous enrollment, who were treated with intravenous belimumab (IVB), subcutaneous belimumab (SCB) or voclosporin (VOC) were included. The proportion of days covered (PDC) and medication possession ratio (MPR) were calculated. Measures of medication persistence were also reported. All endpoints were stratified by therapy and by payer type.
RESULTS: Of 497 identified patients, 43%, 25% and 28% were treated with SCB, IVB and VOC, respectively; the remainder received both SCB and IVB. Baseline patient characteristics were similar between treatment cohorts. In total, 53% of patients had commercial insurance and 44% had Medicaid; the remainder had Medicare Advantage or an unknown insurance type. PDC for the IVB, SCB and VOC cohorts was 0.67, 0.61 and 0.64, respectively; MPR was 0.78, 0.80 and 0.82, respectively. The percentage of patients persistent with medication at 1 year was 57%, 50% and 53% for the IVB, SCB and VOC cohorts, respectively. The benchmark of >80% PDC was achieved by 49% of patients receiving IVB, 42% of patients receiving SCB and 39% of patients receiving VOC. In general, patients with Medicaid had poorer adherence and persistence relative to patients with commercial insurance.
CONCLUSIONS: In this real-world study, overall adherence to, and persistence with, advanced therapies in patients with LN was poor.