Clinical Predictors of Future Nonadherence in Inflammatory Bowel Disease

Severs, Mirjam; Mangen, Marie-Josée J.; Fidder, Herma H.; Valk, Mirthe E. van der; Have, Mike van der; Bodegraven, Ad A. van; Clemens, Cees H.; Dijkstra, Gerard; Jansen, Jeroen M.; Jong, Dirk J. de; Mahmmod, Nofel; Meeberg, Paul C. van de; Jong, Andrea E. van der Meulen–de; Pierik, Marieke; Ponsioen, Cyriel Y.; Romberg‐Camps, Mariëlle; Siersema, Peter D.; Jharap, Bindia; Woude, C. Janneke van der; Zuithoff, Nicolaas P.A.; Oldenburg, Bas

doi:10.1097/mib.0000000000001201

Cited by 45 publications

(28 citation statements)

References 57 publications

(36 reference statements)

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“…However, the decision to stop treatment in patients in remission or in patients with mild side effects is more difficult and is influenced by factors such as doctor and patient preference, treatment duration, treatment adherence and costs. It is known that adherence to long-term treatment is generally low, which is associated with suboptimal treatment outcomes and this also might be a reason to stop treatment [20,21].…”

Section: Introductionmentioning

confidence: 99%

Relapse rates and predictors for relapse in a real-life cohort of IBD patients after discontinuation of anti-TNF therapy

Bots

Kuin

Ponsioen

et al. 2019

Scandinavian Journal of Gastroenterology

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Objective: We investigated relapse rates after anti-tumor necrosis factor (anti-TNF) withdrawal in inflammatory bowel disease (IBD) patients, response to restart of anti-TNF treatment and predictors for relapse. Methods: IBD patients in remission receiving infliximab or adalimumab treatment for !1 year who discontinued treatment were included. Relapse rates and predictors for relapse were studied using survival and Cox regression analysis. Results: In total, 101 patients were included (77 CD, 24 UC). A total of 56 patients (55%) experienced a relapse (CD 38, UC 18) with a median time to relapse of 32 and 18 months in CD and UC, respectively. Of patients that were retreated with the same anti-TNF agent, 84% responded. A trough serum concentration !2 mg/ml within 1 year prior to anti-TNF discontinuation was associated with a higher relapse rate in CD patients (HR 2.89; p ¼ .018), which was more evident in patients requiring retreatment with biologicals, bowel-related surgery or experimental medication (HR: 4.18; p ¼ .009). A young age (<17 years) at diagnosis was associated with a higher relapse rate (HR: 2.29; p ¼ .040) and fecal calprotectin levels <25 mg/g with a lower relapse rate in CD patients (HR: 0.34; p ¼ .041). Relapse rates, requiring treatment with biologicals or experimental medication, was lower in UC patients who continued immunosuppressive treatment (HR: 0.26; p ¼ .042). Conclusions: Approximately 55% of patients relapsed after anti-TNF withdrawal with a median time to relapse of 32 and 18 months in CD and UC, respectively. Retreatment with the same anti-TNF was successful in 84% of patients.

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Section: Introductionmentioning

confidence: 99%

Relapse rates and predictors for relapse in a real-life cohort of IBD patients after discontinuation of anti-TNF therapy

Bots

Kuin

Ponsioen

et al. 2019

Scandinavian Journal of Gastroenterology

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“…Rectal use of 5-aminosalicylic acid (5-ASA) along with the use of corticosteroids were reported to be positive predictors of persistence to treatment at 3 months, while the use of corticosteroids at 12 months was no longer a positive predictor. In a multicenter, prospective cohort study including 1,558 patients with CD and 1,054 patients with UC, younger age at diagnosis, flares, feelings of anxiety or depression, and nonadherence were associated with future nonadherence to treatment [13]. A recent study from Bager et al [2] reported young age and smoking as predictors of nonadherence, while high adherence rates were explained by high patient satisfaction and high degree of shared decision making.…”

Section: Introductionmentioning

confidence: 99%

Patient Preference and Physician Perceptions of Patient Preference for Oral Pharmaceutical Formulations: Results from a Real-Life Survey

et al. 2018

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Background: Pharmaceutical treatment prescribed according to patient preference for a formulation may have a positive impact on adherence to treatment and consequently on treatment outcomes. Aim: This study aimed at understanding patient preference for pharmaceutical formulations and attributes that trigger patient preference and physician perception of patient preference. Methods: Between August and September 2017, gastroenterologists and patients with mild to moderate ulcerative colitis from France, Germany, Spain, and the UK participated in an online survey. The investigation was exploratory in nature, and descriptive results are presented. Results: Patient (n = 380) preference appears to be driven by the appearance (format, shape, size, and color – 44%), number of units per administration (39%), and number of administrations per day (17%). Gastroenterologist (n = 159) preference is instead driven by the number of administrations per day (55%), number of units per day (26%), and tablet size (19%). Overall, 254 (67%) patients preferred a tablet formulation, 111 (29%) preferred granules, and 15 (4%) other formulations. According to gastroenterologist perception of patient preference, only 49% of patients prefer tablets, 38% prefer granules, and 13% have no preference. After switching from granules to tablets, 25% patients expressed negative feelings for granules. However, after switching from tablets to granules, 44% of patients still have positive perceptions of tablets. Among patients receiving tablets (n = 255), 18 (7%) perceived their treatment to be not at all effective versus 16 (13%) patients receiving granules (n = 125). A similar proportion of patients in the two groups perceived their treatment as extremely effective (48 vs. 46%, respectively). Conclusions: Patients generally prefer tablets. Patient and gastroenterologist perception of patient preference for different oral drug formulations is triggered by the same attributes but with inverse importance. To improve adherence, patients should be involved in the choice of the treatment formulation.

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“…This might suggest the lack of understanding of the disease in patients with a low education level, even though a professional gastroenterologist provided adequate comprehensive guidance. A previous study conducted by Severs et al also showed that altering the perception of an illness could be an approach to improve adherence behavior [17]. To some extent, other factors, such as an uninsured status, a low income, and anxiety related to the side effects of the medicine, also played a role in adherence to the guidelines.…”

Section: Discussionmentioning

confidence: 95%

Real-World Experience with AGA Guidelines in the Management of Crohn’s Disease following Ileocolonic Resection: A Retrospective Cohort Study

Tang

Liu

et al. 2020

Gastroenterology Research and Practice

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Background. Postoperative endoscopic recurrence (PER) is common in patients with Crohn’s disease (CD) after surgery. The impact of the American Gastroenterological Association (AGA) guideline adherence on PER in real life remains unclear. Methods. The postoperative management of CD patients undergoing ileocolonic resection with anastomosis from 2017 to 2018 was conducted based on the AGA guidelines. Colonoscopies were performed within one year after surgery. Clinical data and risk factors for endoscopic recurrence were analyzed focusing on postoperative pharmacological prophylaxis. Results. All patients were at a high risk of postoperative recurrence according to the AGA guidelines. PER occurred in 29 (28.7%) of these patients. The overall PER rate was 39.2% at one year. The PER rate in patients treated with nitroimidazole, thiopurines, infliximab, or a combination of thiopurines and infliximab for postoperative prophylaxis was 88.1%, 34.1%, 20.5%, and 0%, respectively. Cox regression showed that smoking at the time of surgery and AGA guideline adherence were independent factors associated with PER (HR: 3.75, 95% CI: 1.36-10.33, P=0.01; HR: 0.36, 95% CI: 0.15-0.86, P=0.02). In addition, further investigation revealed that educational background was the main factor related to patients’ nonadherence to AGA guidelines. Conclusions. The majority of CD patients who undergo surgery in clinical practice may be at a high risk of disease recurrence. Thiopurines and infliximab are effective in preventing endoscopic recurrence. Guideline nonadherence is associated with PER at one year, thus indicating that there is room for improvement in adherence to the AGA guidelines.

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Clinical Predictors of Future Nonadherence in Inflammatory Bowel Disease

Abstract: Lower age at diagnosis, flares, feelings of anxiety or depression, and nonadherence are associated with future nonadherence in patients with IBD. Altering illness perceptions could be an approach to improve adherence behavior.

Cited by 45 publications

References 57 publications

Relapse rates and predictors for relapse in a real-life cohort of IBD patients after discontinuation of anti-TNF therapy

Relapse rates and predictors for relapse in a real-life cohort of IBD patients after discontinuation of anti-TNF therapy

Patient Preference and Physician Perceptions of Patient Preference for Oral Pharmaceutical Formulations: Results from a Real-Life Survey

Real-World Experience with AGA Guidelines in the Management of Crohn’s Disease following Ileocolonic Resection: A Retrospective Cohort Study

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