Abstract
Background/Objective Non-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.
Methods This 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.
Results Cannabis 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.
Conclusions Non-adherence to recommended therapy and medical cannabis use are associated with a significant increase in the development of end-stage renal disease in SLE.
Footnotes
Compliance with Ethical Standards: Disclosure of potential conflicts of interest: There were no conflicts of interest of any of the authors in this study. This study was funded by US National Institutes of Health research grants (R01 NS035708 and UL1TR001449).
Research involving Human Participants and/or Animals: This research was approved by the institutional review board (IRB) and was in adherence with the Helsinki Declaration and subsequent revisions. Additional IRB approval was obtained prior to analyzing the de-identified database in relation to medical cannabis use.
Informed consent: Each subject provided written informed consent Author Approvals: All authors have seen and approved of the manuscript.