Remission in Pediatric Inflammatory Bowel Disease Correlates With Prescription Refill Adherence Rates.
The aim of the study was to use pharmacy benefit management (PBM) prescription claims data to assess refill adherence in pediatric inflammatory bowel disease (IBD) and correlate adherence with clinical outcomes in pediatric IBD.



We identified 362 pediatric patients with IBD seen at Washington University from 9/1/2012 to 8/31/2013 and matched them within Express Scripts' member eligibility files for clients allowing use of prescription drug data for research purposes. Maintenance IBD medication possession ratios (MPR) were determined through PBM prescription claims data and chart review. Demographic and prospectively captured physician global assessments (PGA) were retrospectively extracted from the medical record. MPR was analyzed as continuous data and also dichotomized as greater or less than 80%.



Among our 362 patients, we matched 228 (63%) within Express Scripts' eligibility data files. Of those, 78 patients were continuously eligible for benefits and had at least one outpatient prescription IBD medication prescribed. Their mean MPR was 0.63 ± 0.31 (standard deviation) and 40% had an MPR ≥80%. Patients in clinical remission had a higher mean MPR than those with an active PGA (0.72 ± 0.28 vs 0.51 ± 0.32, P = 0.002) and patients whose MPR were ≥80% were more likely to have a PGA of remission than those with whose MPR were <80% (84% vs 43%, P = <0.001).



We found a significant association between refill adherence and clinical remission. Nonadherence was common and was more common in adolescents. Use of PBM databases to identify and intervene on patients with poor adherence may improve outcomes in pediatric IBD.
*Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University in St Louis School of Medicine †Express Scripts ‡Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, MO.
Charles M
CM
Samson
Douglas
D
Mager
Sharon
S
Frazee
Feliciano
F
Yu
D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002648:Child; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy*; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy*; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D060828:Induction Chemotherapy; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D016903:Drug Monitoring
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents