Risk Factors for Medication Nonadherence to Self-Injectable Biologic Therapy in Adult Patients With Inflammatory Bowel Disease

Abstract

Background In inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), nonadherence to biologic therapy increases risk of disease flare. The aim of this study was to identify risk factors for nonadherence. Methods This was a single-center retrospective study evaluating patients with IBD treated at a tertiary care center and prescribed self-injectable biologic therapy using the center’s specialty pharmacy. Adherence was defined using medication possession ratio (MPR). Nonadherence was defined as MPR <0.86. Results Four hundred sixty patients (n = 393 with CD and n = 67 with UC) were evaluated with mean MPR (interquartile range) equaling 0.89 (0.48–1). Overall, 69% of patients were adherent (defined as MPR ≥0.86), 66% of patients with CD and 87% of patients with UC. In univariate analysis, several factors increased risk of nonadherence: CD diagnosis, insurance type, psychiatric history, smoking, prior biologic use, and narcotic use (P < 0.05). In multivariable analysis, Medicaid insurance (odds ratio [OR], 5.5; 95% confidence interval [CI], 1.85–15.6) and CD diagnosis (OR, 2.8; 95% CI, 1.3–6.0) increased risk of nonadherence. In CD, as the number of risk factors increased (narcotic use, psychiatric history, prior biologic use, and smoking), the probability of nonadherence increased. Adherence was 72% in patients with 0–1 risk factors, decreasing to 62%, 61%, and 42% in patients with 2, 3, and 4 risk factors, respectively (P < 0.05). Conclusions This study identified risk factors for nonadherence to biologic therapy. In patients with CD, the probability of nonadherence increased as the number of risk factors increased.

Knowledge of disease and self‐management of adolescents with inflammatory bowel diseases

“…In another study, age over 18 years was associated with a better knowledge of diagnosis and medication names than age under 14 years (94% and 89% compared with 45% and 58%, respectively). Similar to our study, others also reported 38%‐66% of medication non‐adherence in paediatric‐onset IBD, whereas adults show a better adherence to the treatment (69%‐82%) . A structured transition service was perceived as very important by 80% paediatric gastroenterologists, while 79% of adult gastroenterologists identified inadequacies in the preparation for transfer .…”

“…Our findings, strengthened by the mentioned above studies, reinforce the importance of adopting a structured transition plan and assessment of transition readiness in IBD centres and may suggest that the transition process should begin at an older age with engagement of patient, their parents and treating physicians to this process …”

Janus Kinase inhibitors in the New Treatment Paradigms of Inflammatory Bowel Disease

“…In a recent single-centre study from the USA, a retrospective analysis revealed that 69% of patients were adherent to the self-injectable biologic. 43 In a study evaluating adherence to an oral drug [5-ASA] in quiescent/mildly active UC, patients identified that baseline non-adherence was 52.4%. Even an educational effort was unable to increase the rate of adherence.…”

Chronic opioid use is associated with early biologic discontinuation in inflammatory bowel disease

“…Furthermore, previous studies have found chronic opioid use in IBD is associated with worse surgical outcomes, longer hospital stays and increased mortality 8,9 . Many predictors of chronic opioid use are associated with poorer outcomes in IBD such as smoking, depression and therapeutic non‐compliance 5,10 . We suspect that chronic opioid use may further interfere with productive therapy by enhancing patient behaviours that compromise effective clinical management.…”