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P178. An audit of adherence to anti-TNF therapy in patients with inflammatory bowel disease

J. Duncan1, M. Sastrillo1, J. Baker2, L. Younge2, S. Anderson1, J. Sanderson1, J. Lindsay2, P.M. Irving1

1Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom; 2Bart's & The London NHS Trust, London, United Kingdom

Introduction: Poor adherence to medication is an area of concern in the management of IBD and is associated with worse clinical outcomes and increased healthcare costs. Anti-TNF therapy is increasingly used in the management of IBD. There are two Anti-TNF agents currently available to treat IBD in the UK: Adalimumab which is self-administered at home and Infliximab, administered by a healthcare professional, normally in the hospital setting. Accordingly potential barriers to adherence vary between the two drugs though little is known about adherence to these medications.

Aims: The aims of the study were to assess: adherence to adalimumab and infliximab in patients managed at two large IBD tertiary referral centres; adherence to other IBD medication in this cohort; and reasons for poor adherence.

Methods: We reviewed adherence to Anti-TNF therapy in patients with IBD over the preceding 12 months by recording postponement of, or failure to attend, scheduled Infliximab infusions along with the frequency of, and reasons for, missed infusions. In patients self-administering Adalimumab we assessed adherence using the Medication Adherence Report Scale (MARS) [1] a validated 5 point Likert scale assessing medication adherence. Additionally we recorded reasons for missed or delayed injections. Missed/postponed infusions or doses for medical reasons (e.g. infections) were not counted as failure to adhere. Adherence to (MARS), and reasons for non-adherence were also recorded for 5-ASA and immunomodulators.

Results: A total of 106 patients were included (tables 1, 2).

Table 1
 N
IFX:ADA82:24
M:F55:50
Age (Median (range))32 (17–59)
Time on treatment17 (1–110)
Table 2
 IFXADA
Crohn's7424
UC/IBD-U60
OFG20

There was no difference in the proportion of patients who failed to adhere to their Anti-TNF therapy completely (p = 0.79) (table 3).

Table 3
 IFX (n = 82)ADA (n = 24)
Missed or delayed any dose19 (23%)5 (21%)

Infliximab: 5 patients missed infusions on a total of 8 occasions. 14 patients postponed a total of 32 infusions. Of those who failed to adhere to their scheduled infusions:16 cited inconvenience as their major reason and 1 forgot. In 2 the reason for failing to attend was not known.

Adalimumab: 3 people occasionally missed doses; 2 forgot and 1 cited inconvenience. 4 people delayed doses, most of whom forgot although one cited the route of administration. The median MARS score was 25 (range 22–25).

49 patients were taking a thiopurine, 8 methotrexate. 20 of 57 (35%) patients admitted to incomplete adherence to medication. The median MARS score was 25 (range 18–25). The most common reason for non adherence was that they forgot to take their medication.

18 patients were taking 5-ASA of whom 8 admitted to poor adherence. The median MARS score was 25 (range 15–25). Poor adherence was most commonly related to forgetting to take medication.

Conclusions: Adherence to Anti-TNF therapy is generally good. While the challenges to adherence are different for the two drugs, overall adherence is similar for both infliximab and adalimumab.

1. Horne R. The medication adherence report scale. University of Brighton, Brighton UK, 2004.