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Using Medicaid data from 2000-2006, 9,600 hydroxychloroquine new users were compared to 3,829 new users of immunosuppressive agents (IS) in patients with SLE. They assessed adherence using the MPR - the medication possession ratio. The mean MPR for HCQ was 47.8% and 42.7% for IS. Nonadherence (<80% MPR) was seen in 79% of HCQ users and 83% of IS users were nonadherent. The HCQ risk of ED visits was 55% higher and hospitalization risk was 37% higher if the patients were no adherent. Similarly, the IS nonadherent patients were 64% more likely to visit the ED or be hospitalized (67%) compared to the adherent patients.