Adherence to treatment in inflammatory bowel disease.
OBJECTIVE
Adherence to therapy is important to ensure success. We wanted to explore this feature in patients with inflammatory bowel disease.


METHODS
We explored adherence to treatment and its modifiers in 40 patients with inflammatory bowel disease using a battery of tests.


RESULTS
A 67% of patients (95% CI: 51-81%) acknowledged a certain degree of involuntary nonadherence, and 35% (95% CI: 20-51%) of voluntary nonadherence. Overall, 72% (95% CI: 56-85%) of patients had some form of nonadherence. An objective correlation of these self-reported data was assessed by the determination of urine salicylate levels in the subset of patients treated with mesalazine or its derivatives (15 cases). Two of them (13%) had no detectable urinary drug levels, indicating complete nonadherence. Voluntary nonadherence was higher in patients with lower scores in the intestinal (p = 0.02) and social areas (p = 0.015) of IBDQ-32, as well as in those with less active Crohn s disease (p < 0.005), patients with high depression scores and high patient-physician discordance (p = 0.01), patients with long-standing disease (p = 0.057), patients who considered themselves not to be well informed about the treatment they were getting (p = 0.04) or who trusted their attending physicians less (p = 0.03).


CONCLUSIONS
Intentional nonadherence to therapy is prevalent among patients with inflammatory bowel disease. A correction of factors associated to poor adherence could lead to higher therapeutic success.
Service of Digestive Diseases, Hospital Ramón y Cajal, Madrid, Spain.
A
A
López San Román
F
F
Bermejo
E
E
Carrera
M
M
Pérez-Abad
D
D
Boixeda
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use / Q000652:urine; D003093:Colitis, Ulcerative / Q000188:drug therapy; D003424:Crohn Disease / Q000188:drug therapy; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use / Q000652:urine; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
D000894:Anti-Inflammatory Agents, Non-Steroidal; D005765:Gastrointestinal Agents; D019804:Mesalamine