Medication-Taking Behavior in a Cohort of Patients with Inflammatory Bowel Disease

Abstract

Recent studies have shown a low adherence rate to maintenance treatment in patients with inflammatory bowel disease (IBD). We sought to assess the medication-taking behavior in a cohort of patients with IBD. We prospectively included IBD patients from the outpatient clinic who agreed to answer a questionnaire about prescribed treatment and adherence. Physicians registered clinical data including prescribed medications. Two hundred fourteen patients (115 Crohn's disease/99 ulcerative colitis) were included. The most prescribed medications were oral mesalazine (56.5%) and immunomodulators (41.1%). Forty-three percent of patients admitted to occasionally forgetting to take their medication but only 7.5% of them did it voluntary. Oral mesalazine and azathioprine were the drugs with the poorest compliance, with nonadherence rates of 45% and 25% of the total prescribed doses, respectively. The only factor associated with a better adherence was a more complicated course of the disease-steroid dependency, steroid refractoriness, need for infliximab treatment, hospitalization, or surgery (P=.02). Twenty percent of patients admitted to self-medicating. An important proportion of patients with IBD admit to forget some doses of the prescribed medication in the setting of a specialized unit of a referral centre.

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

“…This was not, however, confirmed in all studies [5] . An association between medical adherence and complicated disease course in CD was reported by Spanish authors [14] . Better adherence was significantly associated with a more complicated disease course (steroid dependency, steroid refractoriness, need for infliximab treatment, hospitalization, or surgery) in patients with short disease duration.…”

“…A higher education level and full time employment was also associated with a non-adherent patient behavior in some [5,16,21] , but not all, studies [14] .…”

“…In normal clinical practice, adult studies have revealed medication non-adherence prevalence rates ranging from 35% to 72% [3,5,10,13,14] . For example a cross-sectional study of US outpatients with quiescent ulcerative colitis (UC) found that only 40% were adherent to maintenance mesalazine (mesalamine) therapy [3] .…”

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

“…Broadly speaking the prevalence of thiopurine non-adherence, we report here is similar to that demonstrated in early therapeutic drug monitoring studies of thiopurines in IBD [37][38][39] and to those adherence studies that have used a drug metabolite to define adherence. [8][9][10][11][12] It is, however, lower than rates reported from studies that relied only on questionnaires, 7,13,14,26,[40][41][42][43][44][45][46] pharmacy refill data 3,47 or patient diaries 48 to define non-adherence, which suggest that between 25% and 72%, IBD patients are non-adherent. While these studies are subject to recall, social desirability and concealment biases, this apparent discrepancy probably reflects the fact that most people tell the truth when asked about adherence, and that drug metabolites, although markers of major non-adherence are poor measures of unintentional/partial adherence.…”

Application of Telemedicine for Patients with Inflammatory Bowel Disease: Review of the Literature and Future Implications

“…In the United States, the economic impact of IBD is substantial, estimated at an annual cost of 6.3 billion dollars [3]. Effective treatments for induction and maintenance of remission exist for IBD; however only 40-60% of patients with quiescent UC are adherent to aminosalicylate therapy (5-ASA) [4][5][6][7]. Nonadherence to therapy is not trivial as nonadherent patients are five times more likely to have disease exacerbations [8] and direct health care costs are increased in nonadherent patients [9].…”