Adherence to treatment in inflammatory bowel disease

Abstract

Aim: adherence to therapy is important to ensure success. We wanted to explore this feature in patients with inflammatory bowel disease. Patients and methods: we explored adherence to treatment and its modifiers in 40 patients with inflammatory bowel disease using a battery of tests. Results: a 67% of patients (95% CI: 51-81%) acknowledged a certain degree of involuntary nonadherence, and 35% (95% CI: 20-51%) of voluntary nonadherence. Overall, 72% (95% CI: 56-85%) of patients had some form of nonadherence. An objective correlation of these self-reported data was assessed by the determination of urine salicylate levels in the subset of patients treated with mesalazine or its derivatives (15 cases). Two of them (13%) had no detectable urinary drug levels, indicating complete nonadherence. Voluntary nonadherence was higher in patients with lower scores in the intestinal (p = 0.02) and social areas (p = 0.015) of IBDQ-32, as well as in those with less active Crohn's disease (p < 0.005), patients with high depression scores and high patientphysician discordance (p = 0.01), patients with long-standing disease (p = 0.057), patients who considered themselves not to be well informed about the treatment they were getting (p = 0.04) or who trusted their attending physicians less (p = 0.03). Conclusions: intentional nonadherence to therapy is prevalent among patients with inflammatory bowel disease. A correction of factors associated to poor adherence could lead to higher therapeutic success.

Prevalence, predictors, and clinical consequences of medical adherence in IBD: How to improve it?

“…Sewitch et al [10] found an increased risk of intentional non-adherence to be associated with being treated by the same physician for more than one year, not scheduling another appointment, and greater total discordance between the patient and the physician. Similarly, a higher degree of intentional non-adherence in the study by López San Román et al [31] was associated with greater patient depression and patient-physician discord. Patients trusted their physician less, and considered themselves to be less informed about their treatment.…”

Long‐term oral mesalazine adherence and the risk of disease flare in ulcerative colitis: nationwide 10‐year retrospective cohort from the veterans affairs healthcare system

“…During these visits, routine pill checks can be very helpful through asking the patient to bring in his medication to be inspected by the physician to assess the extent of home utilisation. 29,34 Counselling about the importance of adherence in periods of remissions should be given in the follow-up visits. The major strength of our study lies in the fact that (to our knowledge) this is the first report of nationwide data regarding adherence to mesalazine and the role of adherence in predicting disease flares.…”

Factors associated with thiopurine non-adherence in patients with inflammatory bowel disease

“…High levels of perceived doctor-patient discordance have also been linked to non-adherence. 44,45 To pursue educational and employment commitments, young adults are often highly mobile and frequently change their treating physician, and it is possible that the absence of a fixed point of contact with an IBD physician leads to more non-adherence. The observation that MMP levels were higher in adults is possibly explained by a combination of better adherence and the fact that the adults in this cohort were more often hypermethylators.…”