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

Abstract

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.

Medication Use Patterns and Predictors of Nonpersistence and Nonadherence with Oral 5-Aminosalicylic Acid Therapy

“…6,7 This finding confirms the problem of medication nonadherence in UC patients in the United States. Oral 5-ASA medication use 21 analyzed a large U.S. pharmacy data file to examine persistency with oral 5-ASA therapy in UC patients.…”

“…7,13,[16][17][18]21,26,27 Although a few studies reported that daily dose regimen and formulation do not significantly impact adherence, 7,13 2 current studies using patient surveys revealed that frequent dosing and pill burden were important factors for nonadherence. 16,26 Similarly, 2 patterns varied among patients initiated on different 5-ASA medications.…”

“…[7][8][9][10][11][12][13] Multiple factors associated with nonadherence with UC medications have been identified. 6,7,[13][14][15] These factors include age, gender, newly diagnosed patient status, disease duration, copayment costs, rectal 5-ASA and glucocorticoid use, and drug type and dosing regimens. Some of these studies have reported that adherence is related to dosing regimens, while other studies have not found a correlation between these concepts.…”

“…For example, a few studies in UC patients showed that daily dose, regimen, and formulation do not significantly impact adherence. 7,13 In addition, adherence in UC patients appears to be independent of medication formulation. 13 However, the study conducted by Loftus (2006) from a survey of 1,595 patients with UC showed the most common reasons for nonadherence were "too many pills," "dosing required too many times each day," "medication too inconvenient," and "forgetting to take medication."…”

“…[3][4][5] However, clinical studies have reported medication nonadherence rates from 40% to 72%. 6,7 Current systematic reviews reveal that nonadherence with 5-ASA has substantial clinical implications, including a greater • The present study investigated various medication use patterns including discontinuation, restart, switch, and adherence using "real-world" pharmacy and medical claims data. …”