Medication adherence in inflammatory bowel disease

Abstract

Inflammatory bowel disease (IBD) is a chronic idiopathic inflammatory condition with intestinal and extraintestinal manifestations. Medications are the cornerstone of treatment of IBD. However, patients often adhere to medication poorly. Adherence to medications is defined as the process by which patients take their medications as prescribed. Treatment non-adherence is a common problem among chronic diseases, averaging 50% in developed countries and is even poorer in developing countries. In this review, we will examine the adherence data in IBD which vary greatly depending on the study population, route of administration, and methods of adherence measurement used. We will also discuss the adverse clinical outcomes related to non-adherence to medical treatment including increased disease activity, flares, loss of response to anti-tumor necrosis factor therapy, and so forth. There are many methods to measure medication adherence namely direct and indirect methods, each with their advantages and drawbacks. Finally, we will explore different intervention strategies to improve adherence to medications.

Longitudinal non‐adherence predicts treatment escalation in paediatric ulcerative colitis

“…This finding has critical clinical implications for adherence monitoring and management. First, in contrast to the majority of previous IBD adherence studies, which have utilised a consensus cut‐point and classify non‐adherence as <80% the current study showed that when adherence fell below 86%, the likelihood of treatment escalation significantly increased. Second, the two adherence trajectories did not diverge until month 6, indicating the importance of continued assessment of adherence over at least the first 6 months following diagnosis in order to identify whether adherence is deteriorating and the likelihood that adherence may be a factor in the need for treatment escalation.…”

“…Given the emphasis on achieving optimal nutrition, growth and development in this population, treatment escalation from 5‐ASA is often indicated to promote mucosal healing and avoid steroid dependence. Despite these advances in treatment, compared to adults, the rate of surgical needs in youth with UC remains higher, which may be indicative of continued difficulties with adherence to immunomodulators or biologic medications as reported in the literature . As such, it is important for providers to recognise and intervene around non‐adherence whether the patient is on maintenance therapy or another type of therapy.…”

“…In youth with inflammatory bowel diseases (IBD), medication non‐adherence has also been associated with increased healthcare costs and negative health outcomes, including more frequent flares in disease activity and greater colorectal cancer risk . Research has also associated poor adherence with negative psychosocial outcomes in children and adolescents, including anxiety and depression symptoms and lower health‐related quality of life in those with IBD . Rates of medication non‐adherence in paediatric IBD range from 2% to 93%, and non‐adherence is higher in adolescents compared to younger youth .…”

“…[3][4][5][6] Research has also associated poor adherence with negative psychosocial outcomes in children and adolescents, including anxiety and depression symptoms and lower health-related quality of life in those with IBD. [7][8][9][10] Rates of medication non-adherence in paediatric IBD range from 2% to 93%, and non-adherence is higher in adolescents compared to younger youth. 11,12 This is particularly problematic because up to 20% of patients with Crohn's disease (CD) and 12% of individuals with ulcerative colitis (UC) are diagnosed before the age of 20.…”

Pregnant women with IBD are more likely to be adherent to biologic therapies than other medications

“…In addition to grouping discontinued and not adherent group together, we were unable to generate meaningful results on other adverse pregnancy outcomes, such as stillbirth and small‐for‐gestational age infants (10th percentile) due to the small number of events. Lastly, our definition for adherence to medication while valid, overestimates medication adherence as it assumes that the prescription dispensed matched the patient's consumption; it does not account for patients who may potentially consume less than what is dispensed from community pharmacies …”