Medical Nonadherence, Cannabis Use, and Renal Outcome in Systemic Lupus Erythematosis

Jalil, B. A.; Qualls, C. R.; Cabacungan, R. J.; Sibbitt, W. L.; Gibb, J. I.; Noronha, L. E.; Fields, R. A.; Emil, N. S.; Fangtham, M.; Bankhurst, A. D.

doi:10.1101/389973

bioRxiv · 10.1101/389973

Medical Nonadherence, Cannabis Use, and Renal Outcome in Systemic Lupus Erythematosis

Jalil, B. A.·Qualls, C. R.·Cabacungan, R. J.·Sibbitt, W. L.·Gibb, J. I.·Noronha, L. E.·Fields, R. A.·Emil, N. S.·Fangtham, M.·Bankhurst, A. D.

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Abstract

Background/ObjectiveNon-adherence to recommended medical therapy has been associated with poorer outcomes in systemic lupus erythematosus (SLE). The present research investigated the association of medical non-adherence and cannabis use on renal outcomes of SLE.\n\nMethodsThis was a prospective 5-year longitudinal outcome study of 276 female SLE patients 30.4% who chronically used medical cannabis and 69.5% who did not. Outcomes were determined at 5 years after enrollment in the study.\n\nResultsCannabis use in SLE patients was associated with an increased prevalence of neuropsychiatric SLE (p<0.05), opioid analgesic use (p<0.01), cigarette smoking (p<0.001), and non-adherence to the medical regimen (non-cannabis: 3% non-adherence vs. cannabis use: 95% non-adherence, p<0.001). Within the 5-year period, the cannabis group demonstrated a 53% increase in mortality (p=0.12) and 127% increase in end-stage renal disease requiring dialysis (p<0.001). With logistic regression analysis adjusting for SLE disease activity (SLEDAI-2K), cannabis use was an independent predictor of end-stage renal disease: Odds ratio 2.65 (CI 1.32 - 5.32, p<0.01). Adjusting for SLE disease damage (SLICC/ACR-DI), cannabis use remained an independent predictor of end-stage renal disease: Odds ratio 2.0 (CI 1.26 - 6.23, p<0.01). With multivariable analysis adjusting for non-adherence, the effect of cannabis on end-stage renal disease could be largely attributed to an increase in non-adherence to medical therapy.\n\nConclusionsNon-adherence to recommended therapy and medical cannabis use are associated with a significant increase in the development of end-stage renal disease in SLE.

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Jalil, B. A., Qualls, C. R., Cabacungan, R. J., Sibbitt, W. L., Gibb, J. I., Noronha, L. E., Fields, R. A., Emil, N. S., Fangtham, M., Bankhurst, A. D.. 2018-08-15. Medical Nonadherence, Cannabis Use, and Renal Outcome in Systemic Lupus Erythematosis. https://doi.org/10.1101/389973

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