TY - JOUR
T1 - Clinical Predictors of Future Nonadherence in Inflammatory Bowel Disease
AU - Severs, Mirjam
AU - Mangen, Marie-Josee J.
AU - Fidder, Herma H.
AU - van der Valk, Mirthe E.
AU - van der Have, Mike
AU - van Bodegraven, Ad A.
AU - Clemens, Cees H. M.
AU - Dijkstra, Gerard
AU - Jansen, Jeroen M.
AU - de Jong, Dirk J.
AU - Mahmmod, Nofel
AU - van de Meeberg, Paul C.
AU - van der Meulen-de Jong, Andrea E.
AU - Pierik, Marieke
AU - Ponsioen, Cyriel Y.
AU - Romberg-Camps, Marielle J. L.
AU - Siersema, Peter D.
AU - Jharap, Bindia
AU - van der Woude, Janneke C.
AU - Zuithoff, Nicolaas P. A.
AU - Oldenburg, Bas
AU - COIN Study Group
AU - Dutch Initiative Crohn and Colitis
PY - 2017/9
Y1 - 2017/9
N2 - Background: Nonadherence to medical therapy is frequently encountered in patients with inflammatory bowel disease (IBD). We aimed to identify predictors for future (non) adherence in IBD.Methods: We conducted a multicenter prospective cohort study with adult patients with Crohn's disease (CD) and ulcerative colitis (UC). Data were collected by means of 3-monthly questionnaires on the course of disease and healthcare utilization. Medication adherence was assessed using a visual analogue scale, ranging from 0% to 100%. Levels <80% were considered to indicate nonadherence. The Brief Illness Perception Questionnaire was used to identify illness perceptions. We used a logistic regression analysis to identify patient-and disease-related factors predictive of nonadherence 3 months after the assessment of predictors.Results: In total, 1558 patients with CD and 1054 patients with UC were included and followed for 2.5 years. On average, 12.1% of patients with CD and 13.3% of patients with UC using IBD-specific medication were nonadherent. Nonadherence was most frequently observed in patients using mesalazine (CD), budesonide (UC) and rectally administrated therapy (both CD and UC). A higher perceived treatment control and understanding of the disease were associated with adherence to medical therapy. Independent predictors of future nonadherence were age at diagnosis (odds ratio [OR]: 0.99 per year), nonadherence (OR: 26.91), a current flare (OR: 1.30) and feelings of anxiety/depression (OR: 1.17), together with an area under the receiver-operating- characteristics curve of 0.74.Conclusions: Lower age at diagnosis, flares, feelings of anxiety or depression, and nonadherence are associated with future nonadherence in patients with IBD. Altering illness perceptions could be an approach to improve adherence behavior.
AB - Background: Nonadherence to medical therapy is frequently encountered in patients with inflammatory bowel disease (IBD). We aimed to identify predictors for future (non) adherence in IBD.Methods: We conducted a multicenter prospective cohort study with adult patients with Crohn's disease (CD) and ulcerative colitis (UC). Data were collected by means of 3-monthly questionnaires on the course of disease and healthcare utilization. Medication adherence was assessed using a visual analogue scale, ranging from 0% to 100%. Levels <80% were considered to indicate nonadherence. The Brief Illness Perception Questionnaire was used to identify illness perceptions. We used a logistic regression analysis to identify patient-and disease-related factors predictive of nonadherence 3 months after the assessment of predictors.Results: In total, 1558 patients with CD and 1054 patients with UC were included and followed for 2.5 years. On average, 12.1% of patients with CD and 13.3% of patients with UC using IBD-specific medication were nonadherent. Nonadherence was most frequently observed in patients using mesalazine (CD), budesonide (UC) and rectally administrated therapy (both CD and UC). A higher perceived treatment control and understanding of the disease were associated with adherence to medical therapy. Independent predictors of future nonadherence were age at diagnosis (odds ratio [OR]: 0.99 per year), nonadherence (OR: 26.91), a current flare (OR: 1.30) and feelings of anxiety/depression (OR: 1.17), together with an area under the receiver-operating- characteristics curve of 0.74.Conclusions: Lower age at diagnosis, flares, feelings of anxiety or depression, and nonadherence are associated with future nonadherence in patients with IBD. Altering illness perceptions could be an approach to improve adherence behavior.
KW - medication adherence
KW - Crohn's disease
KW - ulcerative colitis
KW - prediction
KW - QUIESCENT ULCERATIVE-COLITIS
KW - ANTI-TNF THERAPY
KW - MEDICATION ADHERENCE
KW - CROHNS-DISEASE
KW - ILLNESS PERCEPTIONS
KW - MANAGEMENT
KW - OUTCOMES
KW - MODELS
U2 - 10.1097/MIB.0000000000001201
DO - 10.1097/MIB.0000000000001201
M3 - Article
C2 - 28700534
VL - 23
SP - 1568
EP - 1576
JO - Inflammatory Bowel Diseases
JF - Inflammatory Bowel Diseases
SN - 1078-0998
IS - 9
ER -