Characterising medication use and complexity among people with Sjögren’s disease and their relationship with treatment burden: a cross-sectional survey study

Abstract Introduction Sjögren’s is a chronic, systemic autoimmune disease which occurs alone or alongside other autoimmune diseases. Little is known about medication prescribing patterns or treatment complexity, and their impact on the treatment and financial burden experienced by people with Sjögren’s. This study aims to examine medication use and complexity among people with Sjögren’s, and the factors influencing this. Aim To (1) assess medication use and trends of medication use amongst people living with Sjögren’s disease in the Republic of Ireland and its complexity and the associated treatment burden, and (2) understand the factors associated with medication complexity and treatment burden. Methods A cross-sectional survey was administered using REDCap survey platform where people with Sjögren’s in Ireland were invited to participate (phone and postal survey options were also available). Information collected included demographics (age, ethnicity, gender, education) prescribed medications (name, strength, dose, formulation), and co-morbidities. Information was also gathered on healthcare utilisation and expenses, treatment burden using the Multimorbidity Treatment Burden Questionnaire (MTBQ) and financial burden using the COST tool.1 Medication use was summarised as the number of medications, presence of polypharmacy (5+ medications), and prevalence of specific medications/drug classes. The medication complexity regimen index (MCRI) was applied to each participant’s medication details, capturing the number of medications, doses, and formulations.2 Factors associated with medication regimen complexity (demographics, number and types of medications and co-morbidities) were evaluated using multivariable linear regression. The reported treatment burden for each participant was calculated and categorised based on the predefined categories of burden. Similarly, the associations between medication complexity and treatment burden were evaluated. Stata version 18.5 was used for analysis. Results Among 95 participants who have completed surveys, the number of medications reported ranged from 0–37 medications per participant, with the mean number of medications identified as 6.58 (indicating the presence of polypharmacy) and a reported mean medication complexity score of 18.62 (range 0–105). Overall, 51.06% of participants reported a high level of treatment burden (MTBQ score =22) with 91.49% of participants reporting a medium (burden score 10–22) or high treatment burden. A statistically significant relationship was identified between total number of medications and treatment burden (p-value = 0.005), and medication complexity and treatment burden (p-value = 0.015), however there is a strong indication that other factors (R2-value of 0.0829 and 0.0624 respectively) may influence treatment burden. Conclusion This study is novel in comprehensively assessing medication use and treatment burden amongst people with Sjögren’s and is strengthened by the use of validated measures of treatment burden and medication complexity. Limitations of this research are that as a self-completion survey, there may be volunteer bias, and findings may only be applicable in the Irish population. While there are other factors such as socioeconomic status and health literacy which could influence the association between medicines and treatment burden, these findings suggest significant treatment burden at least partly related to the number of medicines. This suggests a need to optimise care and reduce treatment burden for this patient cohort.