Adherence to treatment in inflammatory bowel disease

Abstract

AIM: Adherence to therapy is important to ensure success. We wanted to explore this feature in patients with inflammatory bowel disease. PATIENTS AND 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.