title: Inflammatory bowel disease patients are frequently nonadherent to scheduled induction and maintenance infliximab therapy: A Canadian cohort study.
abstract: BACKGROUND
  Adherence to maintenance medication regimens in inflammatory bowel disease patients has traditionally been poor. Although infliximab has demonstrated efficacy in inducing and maintaining disease remission, adherence to regularly scheduled infliximab infusions is required to maintain therapeutic trough drug levels and prevent the development of anti-infliximab antibodies.
  
  
  OBJECTIVE
  To characterize patient adherence to regularly scheduled induction and maintenance infliximab infusions.
  
  
  METHODS
  A retrospective cohort study was conducted evaluating adult outpatients with Crohn disease or ulcerative colitis on an induction or maintenance regimen of regularly scheduled infliximab from 2008 to 2010 at the University of Alberta (Edmonton, Alberta). Nonadherence was defined by a discrepancy of >72 h between the scheduled date of infusion and the actual date of administration. Patients were defined as nonadherent if they received <80% of their infliximab infusions per schedule.
  
  
  RESULTS
  A total of 215 patients (173 Crohn disease, 42 ulcerative colitis) met the inclusion criteria. Patients received a median of 12.0 infliximab infusions (interquartile range 7.0 to 13.0) during the study period; 412 induction and 1837 maintenance infliximab infusions were administered. Of 140 patients, 109 (77.9%) were adherent to their infliximab induction regimen, while 68 of 215 (31.6%) were adherent to their infliximab maintenance regimen. One hundred ninety-eight of 215 (92.1%) patients received at least one delayed maintenance infliximab infusion and 20 (10.1%) received maintenance infusions, on average, >1 week late.
  
  
  CONCLUSIONS
  While three-quarters of patients are adherent to infliximab induction therapy, fewer than one-third remained adherent to their scheduled maintenance infliximab regimen.
authors.forename: Christopher
authors.initials: C
authors.lastname: Ma
authors.forename: Chad J
authors.initials: CJ
authors.lastname: Evaschesen
authors.forename: Grenvil
authors.initials: G
authors.lastname: Gracias
authors.forename: Vivian W
authors.initials: VW
authors.lastname: Huang
authors.forename: Darryl K
authors.initials: DK
authors.lastname: Fedorak
authors.forename: Karen I
authors.initials: KI
authors.lastname: Kroeker
authors.forename: Levinus A
authors.initials: LA
authors.lastname: Dieleman
authors.forename: Brendan P
authors.initials: BP
authors.lastname: Halloran
authors.forename: Richard N
authors.initials: RN
authors.lastname: Fedorak
mesh_terms: D000328:Adult; D002170:Canada; D004334:Drug Administration Schedule; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D006801:Humans; D060828:Induction Chemotherapy / Q000706:statistics & numerical data*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000523:psychology; D000069285:Infliximab / Q000008:administration & dosage*; D060046:Maintenance Chemotherapy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016903:Drug Monitoring
chemical_list: D005765:Gastrointestinal Agents; D000069285:Infliximab