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KMID : 0988920180160040571
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Intestinal Research
2018 Volume.16 No. 4 p.571 ~ p.578
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Medication non-adherence in inflammatory bowel diseases is associated with disability
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Perry Jonathan
Chen Andy
Kariyawasam Viraj
Collins Glen
Choong Chee
Teh Wei Ling
Mitrev Nikola
Kohler Friedbert
Leong Rupert Wing Loong
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Abstract
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Background/Aims: Medication non-adherence is common in inflammatory bowel diseases (IBD). The short-term consequences of non-adherence include increased disease relapse but the long-term impact upon patients in terms of daily functional impairment are less well characterized. Identifying negative outcomes, such as disability, may encourage adherence.
Methods: Consecutive ambulatory IBD subjects completed the Medication Adherence Rating Scale (MARS; non-adherence defined as ≤16), Inflammatory Bowel Diseases Disability Index (IBD-DI; disability: <3.5) and Beliefs about Medicines Questionnaire (high necessity/concerns: ≥16). The primary outcome was the association between medication non-adherence and disability. Secondary outcomes were the predictors of these outcomes.
Results: A total of 173 subjects on IBD maintenance medications were recruited (98 Crohn’s disease, 75 ulcerative colitis: median IBD-DI, ?5.0; interquartile range [IQR], ?14.0 to 4.0 and median MARS, 19.0; IQR, 18 to 20) of whom 24% were non-adherent. Disability correlated significantly with medication non-adherence (r=0.38, P<0.0001). Median IBD-DI for non-adherers was significantly lower than adherers (?16.0 vs. ?2.0, P<0.0001). Predictors of disability included female sex (P=0.002), previous hospitalization (P=0.023), management in a referral hospital clinic (P=0.008) and medication concerns (P<0.0001). Non-adherence was independently associated with difficulty managing bowel movements (odds ratio [OR], 3.71; 95% confidence interval [CI], 1.50?9.16, P=0.005), rectal bleeding (OR, 2.69; 95% CI, 1.14?6.36; P=0.024) and arthralgia/arthritis (OR, 2.56; 95% CI, 1.11?5.92; P=0.028).
Conclusions: Medication non-adherence was associated with significantly increased disability in IBD. Female gender, higher disease severity and medication concerns were additional predictors of disability.
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KEYWORD
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Crohn disease, Colitis, ulcerative, Inflammatory bowel diseases, Compliance, Drug
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