Medication adherence and persistence in the treatment of Canadian ulcerative colitis patients: analyses with the RAMQ database

Abstract

BackgroundAlthough high non-adherence to medication has been noticed for ulcerative colitis (UC), little is known about adherence to mesalamine treatments and determinants that can predict adherence. The objective of this study was to assess adherence and persistence to mesalamine treatments and their potential determinants in mild to moderate UC patients in a real-life setting in Quebec, Canada.MethodsA retrospective prescription and medical claims analysis was conducted using a random sample of mesalamine users with UC. For inclusion, patients were required to initiate an oral mesalamine treatment between January 2005 and December 2009. Patients with a diagnosis of Crohn’s disease were excluded. Treatment adherence (medication possession ratio [MPR]) and persistence were evaluated over a 1-year period after the index prescription using the Kaplan-Meier method with log-rank test and stepwise regression to identify potential determinants.ResultsA sample of 1,681 of the new oral mesalamine users (mean age = 55.3) patients was obtained. Overall, the percentage of patients with a MPR of 80% or greater at 12 months was 27.7%, while persistence was 45.5%. Among patients treated with mesalamine delayed/extended-release tablets (Mezavant®), adherence and persistence were 40.9% and 71.9%, respectively. Predictors of high adherence included, male gender (OR=1.3; 95% confidence interval [CI]=1.1–1.6), older age (>60 years; OR=1.6; 95% CI=1.3–2.0) and current use of corticosteroids (OR=1.4; 95% CI=1.1–1.8). Predictors of high persistence included male sex (OR=1.4; 95% CI=1.1–1.7), current use of corticosteroids (OR=1.4; 95% CI=1.1–1.7) and presence of hypertension or respiratory diseases (OR=1.2; 95% CI=1.01–1.55).ConclusionsThe majority of patients with UC exhibited low adherence and persistence to mesalamine treatments. Various determinants of improved adherence and persistence were identified.

The Burden of Inflammatory Bowel Disease

“…The sequelae of this can be seen in the increased rates of depression, and reduced workforce participation reported in patients with ulcerative colitis (UC) or Crohn’s disease (CD) 1,2,3 . In addition, the necessity for chronic medical therapies to maintain clinical remission of the disease generates its own obstacles for patients 4,5 .…”

Use of 5-Aminosalicylic Acid for Treatment of Ulcerative Colitis in Different Dosage Modes

“…Также в крупном открытом исследовании реальной клинической практики по результатам анализа данных около 2 тыс. пациентов с ЯК было подтверждено, что препарат Мезавант (месалазин ММХ) с режимом приема 1 раз в сутки показал наибольшую приверженность по сравнению с препаратами, принимаемыми два и более раза в сутки [46].…”

Randomised non‐inferiority trial: 1600 mg versus 400 mg tablets of mesalazine for the treatment of mild‐to‐moderate ulcerative colitis

“…The primary advantage of less frequent dosing schedules is the potential for greater medication adherence and effectiveness. Community‐based research indicates that adherence and persistence rates for mesalazine are as low as 40%‐60% and 13%‐45% respectively. Evidence that poor adherence translates into reduced effectiveness has been generated by a cohort study that followed 4453 UC patients for a median of 6 years.…”