title: Nonadherence with thiopurine immunomodulator and mesalamine medications in children with Crohn disease.
abstract: OBJECTIVE
  To assess the prevalence of adherence to prescribed medications in children with Crohn disease and to identify possible factors associated with nonadherence.
  
  
  METHODS
  This was a cross-sectional study of 51 pediatric patients with Crohn disease who were prescribed maintenance therapy with a thiopurine immunomodulator (6-mercaptopurine or azathioprine) and/or mesalamine during a 180-day period. Medication adherence rates were calculated from a validated formula using pharmacy records, and nonadherence was defined as a refill rate of <80% of the prescribed medication. Seventy-five percent of patients were prescribed thiopurine immunomodulators and 86% were prescribed mesalamine.
  
  
  RESULTS
  The prevalence of nonadherence was 50% for the thiopurine immunomodulators and 66% for mesalamine. The mean number of emergency department visits for patients adherent to mesalamine was significantly greater than the nonadherent group (P < 0.0008). Having an emergency department visit increased the chances of a patient being adherent to mesalamine therapy by >9-fold (odds ratio, 9.6; 95% confidence interval, 1.87-52.17). The mean number of total health care visits was significantly greater for patients adherent to mesalamine (6.1 +/- 0.8) compared with those who were not adherent (3.0 +/- 0.4) (P < 0.001).
  
  
  CONCLUSIONS
  These findings suggest that nonadherence to thiopurine immunomodulator or mesalamine therapy in pediatric patients with Crohn disease is common. Having a health care visit was associated with being adherent.
authors.affiliation: Department of Pediatrics, Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA. moliva@jhmi.edu
authors.forename: Maria M
authors.initials: MM
authors.lastname: Oliva-Hemker
authors.forename: Vivian
authors.initials: V
authors.lastname: Abadom
authors.forename: Carmen
authors.initials: C
authors.lastname: Cuffari
authors.forename: Richard E
authors.initials: RE
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000188:drug therapy* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use*; D019804:Mesalamine / Q000627:therapeutic use*; D015995:Prevalence; D016312:Treatment Refusal / Q000706:statistics & numerical data*
chemical_list: D007166:Immunosuppressive Agents; D019804:Mesalamine; D015122:Mercaptopurine; D001379:Azathioprine