How Adherent to Treatment With Azathioprine Are Patients With Crohnʼs Disease in Long-term Remission?

Abstract

Most patients with Crohn's disease in longstanding remission had low self-reported adherence to azathioprine. Both male gender and single status were associated with nonadherence to azathioprine, whereas disease factors were not related to self-reported adherence. Patients considered nonadherent to treatment maintained disease remission and a quality of life similar to patients who were adherent to treatment.

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

“…Similarly, in the study of Shale and Riley [21] , in addition to being young, having education beyond the age of 16 years and being in full-time employment, being prescribed a 3-times-a-day regimen was identified as predictor for non-adherence. The need to take medicine during working hours (P = 0.001, OR: 3.5, 95% CI: 2.27-5.26), and multiple daily doses (P = 0.045, OR: 2.8, 95% CI: 0.99-7.70) were significantly associated with non-adherence in adults [22] , which was also confirmed by other studies [20,21] . Similarly, adolescents whose regimen involved more than one daily medication administration had more adherence barriers [26] .…”

“…In contrast, other studies reported low adherence rates after long-term remission [3,22] . Very high non-adherence rates (74.3%) were reported for azathioprine in CD patients who were in long-term (> 48 mo) clinical remission [20] . Moreover, a direct association between adherence and risk of relapse was reported in UC.…”

“…Kane et al [3] and Mantzaris et al [20] related poor adherence with the male gender. In the study by Kane et al [3] non-adherent patients were statistically more likely to be males (67% vs 52% in adherent patients).…”

Socioeconomic deprivation does not influence the severity of Crohnʼs disease

“…19,20 In inflammatory bowel disease adherence to treatment seems to be correlated with disease activity. [21][22][23] Kane et al 23 have shown that nonadherence to medication was up to 60% in patients with quiescent UC, while adherence to thiopurine was more than 90% in out-patients with active CD. 20 Mantzaris et al 22 found that most patients with CD in long-standing remission had self-reported low adherence to treatment.…”

Azathioprine-induced suicidal erythrocyte death

“…[1][2][3][4] It has proven particularly useful in the treatment of inflammatory bowel disease (IBD). [5][6][7][8][9][10] The effect of azathioprine is at least partially due to triggering of lymphocyte apoptosis. [11][12][13][14] Side effects of azathioprine include anemia, which has been attributed to hemophagocytic syndrome and bone marrow suppression.…”