Nonadherence With Thiopurine Immunomodulator and Mesalamine Medications in Children with Crohn Disease

Oliva-Hemker, Maria; Abadom, Vivian; Cuffari, Carmen; Thompson, Richard E.

doi:10.1097/mpg.0b013e31802b320e

Cited by 54 publications

(70 citation statements)

References 38 publications

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“…health beliefs) that affect self-management. However, only a few studies have examined adherence rates in pediatric IBD, with the results indicating the prevalence of nonadherence ranging from 50% to 66% [17,18] . Moreover, special attention should be paid to the method of assessment, because significant differences may be present in objective methods versus subjective self-report methods.…”

Section: Ibdmentioning

confidence: 99%

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

Lakatos¹

2009

WJG

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Inflammatory bowel diseases (IBD) are chronic diseases with a relapsing-remitting disease course necessitating lifelong treatment. However, non-adherence has been reported in over 40% of patients, especially those in remission taking maintenance therapies for IBD. The economical impact of non-adherence to medical therapy including absenteeism, hospitalization risk, and the health care costs in chronic conditions, is enormous. The causes of medication non-adherence are complex, where the patient-doctor relationship, treatment regimen, and other disease-related factors play key roles. Moreover, subjective assessment might underestimate adherence. Poor adherence may result in more frequent relapses, a disabling disease course, in ulcerative colitis, and an increased risk for colorectal cancer. Improving medication adherence in patients is an important challenge for physicians. Understanding the different patient types, the reasons given by patients for non-adherence, simpler and more convenient dosage regimens, dynamic communication within the health care team, a self-management package incorporating enhanced patient education and physician-patient interaction, and identifying the predictors of nonadherence will help devise suitable plans to optimize patient adherence. This editorial summarizes the available literature on frequency, predictors, clinical consequences, and strategies for improving medical adherence in patients with IBD.

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Section: Ibdmentioning

confidence: 99%

“…Age seems to be an important factor, as younger patients tend to be less adherent than older patients [10,18] . In a recent Italian study [22] non-adherence was 43% in patients < 40 years old compared to 34% in those older than 40 years (P = 0.041, OR: 1.5, CI: 1.01-2.13).…”

Section: Age and Disease Durationmentioning

confidence: 99%

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

Lakatos¹

2009

WJG

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“…There is no error-free way to assess adherence and currently no gold standard exists [13].We chose clinician estimate of adherence rather than a self-reporting method such as direct interview or focused questionnaire because the overall accuracy of clinician prediction is estimated at 65% [14]. A number of studies have documented rates of medication nonadherence in pediatric IBD ranging from 38%-66%, depending on the reporter, medication type, and method of assessment (e.g., objective methods versus subjective self-reporting methods) [15,16,17]. In our study, 15.8% of patients were nonadherent to medication.…”

Section: Discussionmentioning

confidence: 99%

Treatment Profile of Pediatric Inflammatory Bowel Disease in Saudi Arabia: Issues in Treatment Adherence

Hasosah¹,

Mouzan²,

Saadah³

et al. 2015

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Background: Inflammatory bowel disease (IBD), with its 3 subgroups: Crohn's disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC), is a chronic relapsing inflammatory disorder of the gastrointestinal (GI) tract. Medication adherence is particularly problematic in pediatric IBD. To date this has not been studied in the Middle East. Objectives: The aim of this study was to describe the treatment modalities of IBD and to evaluate adherence to treatment in a population-based cohort of Saudi children. Methods: A cross-sectional study was conducted in all regions of Saudi Arabia. All participating centers were asked to provide information on IBD medications and adherence to prescribed therapies. Results: 354 children with IBD were identified from our database. The age at diagnosis ranged from 1to 14 years, with 145 (41%) diagnosed with UC, 195 (55%) with CD and 14 (4%) with IC. The most common drugs therapy used in IBD was corticosteroids in CD and 5-ASA in UC. Patients with UC were treated with 5-ASA significantly more than patients with CD (76% vs. 62%; P= 0.004). In contrast, patients with CD were treated with infliximab significantly more than patients with UC (22% vs. 6%; P= 0.000). Overall, 15.8% of patients were non-adherent with patients with CD demonstrating a higher level of nonadherence, although this was not significantly different from UC patients (11% vs. 3.8%; P>0.05). Poor adherence to specific drugs was reported significantly more in CD than UC patients; mesalamine (p= 0.022), steroids (p= 0.021) and thiopurines (p= 0.006). Conclusion: Poor adherence occurs most frequently in CD patients and with 5-ASA, corticosteroids and thiopurines. These data can be used to help care providers and policy makers such as the Ministry Of Health define and quantify the burden of IBD among children in Saudi Arabia. Further research in IBD is required to determine the reasons for nonadherence/ poor adherence in the pediatric IBD population so that strategies can be devised to reduce it. Key Points: Medication adherence is particularly problematic in pediatric inflammatory bowel disease (IBD). We found that steroids and 5-Amino salicylic acids are the most widely used medications in pediatric IBD patients. Nonadherence occurs most frequently with 5-ASA, steroids and thiopurines in Crohns. These data should help health care providers quantify the burden of IBD among children.

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“…Compliance can be a real problem and high rates of non-adherence have been reported (13) . The treatment is by evidence-based algorithms of care.…”

Section: Management Strategymentioning

confidence: 99%

Symposium 6: Young people, artificial nutrition and transitional care Nutrition, growth and puberty in children and adolescents with Crohn's disease

Beattie

2009

Proc. Nutr. Soc.

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Of the individuals who present with Crohn's disease 25% are <18 years of age, mostly adolescent. Nutritional impairment and delayed growth are common at diagnosis and remain an issue during the disease course. Treatment has the primary aim to control symptoms, induce disease remission and achieve normal growth in the long term and includes nutritional support and early use of immunomodulation. Puberty may be discordant and is generally late and final adult height may not be achieved until the late teenage years. Chronic ill health and delayed growth may be accompanied by emotional and intellectual immaturity. These factors, including the varying rates of physical and emotional development, need to be considered during adolescence with multidisciplinary input to ensure that the young patient is appropriately supported. Transition to adult care requires close collaboration between paediatric and healthcare teams with careful attention to nutritional, emotional and educational issues, all of which are relevant in the progression from childhood, through adolescence and to adult life.

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Nonadherence With Thiopurine Immunomodulator and Mesalamine Medications in Children with Crohn Disease

Abstract: These findings suggest that nonadherence to thiopurine immunomodulator or mesalamine therapy in pediatric patients with Crohn disease is common. Having a health care visit was associated with being adherent.

Cited by 54 publications

References 38 publications

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

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

Treatment Profile of Pediatric Inflammatory Bowel Disease in Saudi Arabia: Issues in Treatment Adherence

Symposium 6: Young people, artificial nutrition and transitional care Nutrition, growth and puberty in children and adolescents with Crohn's disease

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