Impact of a patient-support program on mesalamine adherence in patients with ulcerative colitis — A prospective study

Moss, Alan C.; Chaudhary, Nabeel; Tukey, Melissa H.; Junior, J.C.P.; Cury, Dídia Bismara; Falchuk, Kenneth R.; Cheifetz, Adam S.

doi:10.1016/j.crohns.2009.10.002

Cited by 31 publications

(46 citation statements)

References 21 publications

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“…The proportion of patients taking 5-ASA or Aza/MP who had a histological score >3.1 was also similar (33% and 42% respectively). Although we did not measure adherence to these medications directly, prior studies from our patient population have reported over 70% adherence rates 21 .…”

Section: Resultsmentioning

confidence: 99%

Histologic Markers of Inflammation in Patients With Ulcerative Colitis in Clinical Remission

Rosenberg

Nanda

Zenlea

et al. 2013

Clinical Gastroenterology and Hepatology

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110

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Background & Aims Mucosal healing, based on histologic analysis, is an endpoint of maintenance therapy for patients with ulcerative colitis (UC). There are few data on how histologic signs of inflammation correlate with endoscopic and peripheral blood measures of inflammation in these patients. We investigated patterns of histologic features of inflammation in patients with UC in clinical remission, and correlated these with endoscopic and biochemical measures of inflammation. Methods We performed a prospective observational study of 103 patients with UC in clinical remission undergoing surveillance colonoscopy while receiving maintenance therapy with mesalamine or thiopurines; 2674 biopsies were collected from 708 colonic segments. Each colonic segment was evaluated based on the Mayo endoscopic sub-score and the Geboes histology score (0–5.4). Biomarkers were measured in peripheral blood samples. Results Histologic features of inflammation were found in 54% of patients receiving maintenance therapy; 37% had at least moderate inflammation, based on histology scores. Of the 52 patients with endoscopic evidence only of left-sided colitis, 34% had histologic features of inflammation in their proximal colon. Histology scores correlated with endoscopic scores for per-segment inflammation (Spearman’s ρ=0.65; P<.001). Patients with histology scores >3.1 had a significantly higher mean level of C-reactive protein (CRP) than those with scores <3.1. There were no differences among treatment groups in percentages of patients with histologic scores >3.1. Conclusions Patients in clinical remission from UC still frequently have histologic features of inflammation, which correlate with endoscopic appearance. Patients with at least moderate levels of inflammation, based on histologic grading (score >3.1), have higher serum levels of CRP, which could be used as a surrogate marker of histologic inflammation.

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Section: Resultsmentioning

confidence: 99%

Histologic Markers of Inflammation in Patients With Ulcerative Colitis in Clinical Remission

Rosenberg

Nanda

Zenlea

et al. 2013

Clinical Gastroenterology and Hepatology

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110

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“…29 Simple interventions, such as telephone reminders and education, may not be sufficient motivators to correct intentional nonadherence behavior. 30,31 Self-evaluation of the benefits of medical therapy and motivational interviewing may be required to improve the priority of rectal mesalamine adherence in patients' daily lives. 28,30,32 There are a number of limitations to this study.…”

Section: Discussionmentioning

confidence: 99%

Adherence to Rectal Mesalamine in Patients with Ulcerative Colitis

Boyle

Ting

Cury

et al. 2015

Inflammatory Bowel Diseases

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“…We focused on blood-based peripheral biomarkers of endoscopic activity, but did not include validated stool-based markers, such as calprotectin. Finally, we did not measure medication adherence directly, but prior studies from our patient population have reported 70-80% of mesalamine prescriptions are refilled over 6 months (28). …”

Section: Discussionmentioning

confidence: 99%

Predictors of Endoscopic Inflammation in Patients With Ulcerative Colitis in Clinical Remission

Rosenberg¹,

Lawlor²,

Zenlea³

et al. 2013

Inflammatory Bowel Diseases

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Objectives Patients with ulcerative colitis (UC) who are in clinical remission may still have underlying endoscopic inflammation, which is associated with inferior clinical outcomes. The goal of this study was to determine the prevalence of, and factors associated with, active endoscopic disease in patients with UC who are in clinical remission. Design Prospective observational study in a single center. Patients with UC in clinical remission (by SCCAI) were enrolled prospectively at time of surveillance colonoscopy. Disease phenotype, endoscopic activity (Mayo sub-score) and histological score (Geboes) were recorded, and blood was drawn for peripheral blood biomarkers. Results 149 patients in clinical remission were prospectively enrolled in this cohort; 81% had been in clinical remission for > 6 months, and 86% were currently prescribed maintenance medications. At endoscopy 45% of patients in clinical remission had any endoscopic inflammation (Mayo endoscopy sub-score >0) and 13% had scores >1. In a multivariate model, variables independently associated with a Mayo endoscopic score >1 were remission for < 6 months (p=.001), WBC (p=0.01) and CRP (p=0.009). A model combining these three variables had a sensitivity of 94% and a specificity of 73% for predicting moderate-severe endoscopic activity in patients in clinical remission (AUC 0.86). In an unselected sub-group of patients who had peripheral blood mononuclear cell mRNA profiling, GATA3 mRNA levels were significantly higher in patients with endoscopic activity. Conclusions Duration of clinical remission, WCC and CRP can predict the probability of on-going endoscopic activity despite clinical remission in patients with UC. These parameters could be used to identify patients who require intensification of treatment to achieve mucosal healing.

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Impact of a patient-support program on mesalamine adherence in patients with ulcerative colitis — A prospective study

Abstract: This nurse-delivered patient-support program did not significantly improve medication adherence or quality-of-life beyond standard care at short and medium-term time-points. Simply discussing and measuring adherence improved mesalamine adherence in both groups in this study.

Cited by 31 publications

References 21 publications

Histologic Markers of Inflammation in Patients With Ulcerative Colitis in Clinical Remission

Histologic Markers of Inflammation in Patients With Ulcerative Colitis in Clinical Remission

Adherence to Rectal Mesalamine in Patients with Ulcerative Colitis

Predictors of Endoscopic Inflammation in Patients With Ulcerative Colitis in Clinical Remission

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