Strategies to Improve Adherence and Outcomes in Patients with Ulcerative Colitis

Overview

Journal Drugs

Specialty Pharmacology

Date 2008 Dec 20

PMID 19093702

Citations 13

Authors

Sunanda V Kane

Affiliations

Soon will be listed here.

Abstract

This review examines studies of patient adherence to 5-aminosalicylic acid therapy conducted outside the context of a controlled therapy trial, considers the reasons why patients do not adhere to their medication and its consequences, and interventions to improve adherence and disease outcomes. Non-adherence in the inflammatory bowel disease population tends to mirror other chronic illnesses, in the range of 40-60%. Factors that appear to affect adherence include younger age, single status, heavy pill burden, perception of lack of benefit and feeling uninformed about the effect of medication. Three important outcomes of non-adherence include increased risk for disease activity, increased healthcare costs and the possible increased risk of dysplasia/colorectal cancer. Strategies to improve adherence include patient education and 'health literacy', along with discussing patient misperceptions and fears on an individual basis, decreasing the daily regimen and switching to high-dose formulations, and incorporating patient self-management techniques into practice.

Citing Articles

Subcutaneous Infliximab Monotherapy Versus Combination Therapy with Immunosuppressants in Inflammatory Bowel Disease: A Post Hoc Analysis of a Randomised Clinical Trial.

DHaens G, Reinisch W, Schreiber S, Cummings F, Irving P, Ye B Clin Drug Investig. 2023; 43(4):277-288.

PMID: 37004656 PMC: 10066948. DOI: 10.1007/s40261-023-01252-z.

Improving Patient Adherence to Lifestyle Changes for the Management of Gastroesophageal Reflux.

Guadagnoli L, Simons M, McGarva J, Taft T, van Tilburg M Patient Prefer Adherence. 2022; 16:897-909.

PMID: 35411136 PMC: 8994664. DOI: 10.2147/PPA.S356466.

Efficacy and safety of a novel high-dose mesalazine tablet in mild to moderate active ulcerative colitis: a double-blind, multicentre, randomised trial.

Dignass A, Schnabel R, Romatowski J, Pavlenko V, Dorofeyev A, Derova J United European Gastroenterol J. 2018; 6(1):138-147.

PMID: 29435324 PMC: 5802664. DOI: 10.1177/2050640617703842.

Management of Inflammatory Bowel Disease in the Elderly Patient: Challenges and Opportunities.

Ananthakrishnan A, Donaldson T, Lasch K, Yajnik V Inflamm Bowel Dis. 2017; 23(6):882-893.

PMID: 28375885 PMC: 5687915. DOI: 10.1097/MIB.0000000000001099.

Adherence in ulcerative colitis: an overview.

Testa A, Castiglione F, Nardone O, Colombo G Patient Prefer Adherence. 2017; 11:297-303.

PMID: 28260866 PMC: 5328138. DOI: 10.2147/PPA.S127039.

References

Brunner M, Assandri R, Kletter K, Tschurlovits M, Corrado M, Villa R . Gastrointestinal transit and 5-ASA release from a new mesalazine extended-release formulation. Aliment Pharmacol Ther. 2003; 17(3):395-402. DOI: 10.1046/j.1365-2036.2003.01445.x. View

Kane S, Cohen R, Aikens J, Hanauer S . Prevalence of nonadherence with maintenance mesalamine in quiescent ulcerative colitis. Am J Gastroenterol. 2001; 96(10):2929-33. DOI: 10.1111/j.1572-0241.2001.04683.x. View

Lichtenstein G, Kamm M, Boddu P, Gubergrits N, Lyne A, Butler T . Effect of once- or twice-daily MMX mesalamine (SPD476) for the induction of remission of mild to moderately active ulcerative colitis. Clin Gastroenterol Hepatol. 2007; 5(1):95-102. DOI: 10.1016/j.cgh.2006.10.025. View

Kripalani S, Yao X, Haynes R . Interventions to enhance medication adherence in chronic medical conditions: a systematic review. Arch Intern Med. 2007; 167(6):540-50. DOI: 10.1001/archinte.167.6.540. View

Rubin D, LoSavio A, Yadron N, Huo D, Hanauer S . Aminosalicylate therapy in the prevention of dysplasia and colorectal cancer in ulcerative colitis. Clin Gastroenterol Hepatol. 2006; 4(11):1346-50. DOI: 10.1016/j.cgh.2006.08.014. View

Hanauer S, Sandborn W, Kornbluth A, Katz S, Safdi M, Woogen S . Delayed-release oral mesalamine at 4.8 g/day (800 mg tablet) for the treatment of moderately active ulcerative colitis: the ASCEND II trial. Am J Gastroenterol. 2005; 100(11):2478-85. DOI: 10.1111/j.1572-0241.2005.00248.x. View

Moshkovska T, Stone M, Baker R, Mayberry J . Qualitative investigation of patient adherence to 5-aminosalicylic acid therapy in patients with ulcerative colitis. Inflamm Bowel Dis. 2008; 14(6):763-8. DOI: 10.1002/ibd.20404. View

Moody G, Jayanthi V, Probert C, Mac Kay H, Mayberry J . Long-term therapy with sulphasalazine protects against colorectal cancer in ulcerative colitis: a retrospective study of colorectal cancer risk and compliance with treatment in Leicestershire. Eur J Gastroenterol Hepatol. 1996; 8(12):1179-83. DOI: 10.1097/00042737-199612000-00009. View

Kane S, Holderman W, Jacques P, Miodek T . Once daily versus conventional dosing of pH-dependent mesalamine long-term to maintain quiescent ulcerative colitis: Preliminary results from a randomized trial. Patient Prefer Adherence. 2009; 2:253-8. PMC: 2770408. DOI: 10.2147/ppa.s3698. View

10.

Kane S, Huo D, Magnanti K . A pilot feasibility study of once daily versus conventional dosing mesalamine for maintenance of ulcerative colitis. Clin Gastroenterol Hepatol. 2004; 1(3):170-3. DOI: 10.1053/cgh.2003.50025. View

11.

Dickinson R, King A, Wight D, Hunter J, Neale G . Is continuous sulfasalazine necessary in the management of patients with ulcerative colitis? Results of a preliminary study. Dis Colon Rectum. 1985; 28(12):929-30. DOI: 10.1007/BF02554309. View

12.

Hall N, Rubin G, Hungin A, Dougall A . Medication beliefs among patients with inflammatory bowel disease who report low quality of life: a qualitative study. BMC Gastroenterol. 2007; 7:20. PMC: 1896170. DOI: 10.1186/1471-230X-7-20. View

13.

Eaden J, Abrams K, Ekbom A, Jackson E, Mayberry J . Colorectal cancer prevention in ulcerative colitis: a case-control study. Aliment Pharmacol Ther. 2000; 14(2):145-53. DOI: 10.1046/j.1365-2036.2000.00698.x. View

14.

Velayos F, Terdiman J, Walsh J . Effect of 5-aminosalicylate use on colorectal cancer and dysplasia risk: a systematic review and metaanalysis of observational studies. Am J Gastroenterol. 2005; 100(6):1345-53. DOI: 10.1111/j.1572-0241.2005.41442.x. View

15.

Ardizzone S, Petrillo M, Imbesi V, Cerutti R, Bollani S, Bianchi Porro G . Is maintenance therapy always necessary for patients with ulcerative colitis in remission?. Aliment Pharmacol Ther. 1999; 13(3):373-9. DOI: 10.1046/j.1365-2036.1999.00473.x. View

16.

Stone M, Mayberry J, Baker R . Prevalence and management of inflammatory bowel disease: a cross-sectional study from central England. Eur J Gastroenterol Hepatol. 2003; 15(12):1275-80. DOI: 10.1097/00042737-200312000-00004. View

17.

Rogler G, Brand K, Vogl D, Page S, Hofmeister R, Andus T . Nuclear factor kappaB is activated in macrophages and epithelial cells of inflamed intestinal mucosa. Gastroenterology. 1998; 115(2):357-69. DOI: 10.1016/s0016-5085(98)70202-1. View

18.

Levy R, Feld A . Increasing patient adherence to gastroenterology treatment and prevention regimens. Am J Gastroenterol. 1999; 94(7):1733-42. DOI: 10.1111/j.1572-0241.1999.01200.x. View

19.

Riley S, Mani V, GOODMAN M, Lucas S . Why do patients with ulcerative colitis relapse?. Gut. 1990; 31(2):179-83. PMC: 1378376. DOI: 10.1136/gut.31.2.179. View

20.

Davis T, Wolf M, Bass 3rd P, Thompson J, Tilson H, Neuberger M . Literacy and misunderstanding prescription drug labels. Ann Intern Med. 2006; 145(12):887-94. DOI: 10.7326/0003-4819-145-12-200612190-00144. View