P505. Factors influencing adherence to treatment with anti-TNF agents in ulcerative and Crohn's disease patients: a prospective study
N. Borruel1, E. Navarro1, V. Robles1, A. Torrejon1, F. Casellas1, 1UACC. Digestive System Reserach Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
Adherence to treatment is strongly related with efficacy especially in anti-TNF therapy where real dose could be critical.
Objective: To assess adherence to anti-TNF treatment in patients with Crohn's disease (CD) and ulcerative colitis (UC).
Six-month prospective study in UC and CD patients treated with infliximab (IFX) or adalimumab (ADA) at least for the last 6 months. Treatment was indicated in the basis of clinical practice at standard doses (IFX 5 mg/kg/4–8 weeks, ADA 40 mg e.o.w./e.w). Global treatment adherence was assessed by Morisky Medication Adherence Scale (MMAS-8), considering a patient adherent if the punctuation is 8 in the four visits (32 points). Specific anti-TNF adherence was assessed by evaluation of number of delayed (>24h and <6 days) and missing doses (>6 days).
131 patients were included in the study (70F/61M; median age 38.5, 18–71), 99 CD and 32 UC patients. Seventy patients were treated with IFX and 61 with ADA. Indication for therapy was mainly steroid-dependency in UC (85%) and steroid-dependency refractory to immunosupresants (49%) and fistulising disease (32%) in CD patients. At the end of the study period, complete adherent patients were only 38.5%. The only factor associated with adherence was type of disease, as UC patients were five times more adherent than CD patients. MMAS-8 score was 6.95±0.13 at entry, 7.14±0.11 at week 8, 7.26±0.12 at week 16 and 7.23±0.11 at week 24 showing a significant increase in adherence after entry (p < 0.05) suggesting a positive effect of monitoring. Low global adherence is related with more missing and delayed doses of anti-TNF therapy (p < 0.05). Cumulative delayed (4.5%) or missed doses (4.4%) were of 8.9%. During the study, 30 patients missed 44 doses, 38 in ADA group (4.7% of total doses) and 6 in IFX group (2.9% of total doses). Reasons to miss doses were mainly infections (26/44; 59%) and generally indicated by doctors/nurses (36/44; 81%). 26 patients delayed 45 doses, 39 in ADA group (4.9% of total doses) and 6 in IFX group (2.9% of total doses). Reasons to delay doses was mainly unjustified as trips and forgetfulness (31/45; 68%) and less frequently infections (10/45; 22%) and generally decided by the patient (37/45; 82%) without medical counselling. Rate of missed or delayed doses was not significantly different between IFX and ADA groups.
Adherence to anti-TNF treatment in CD and UC patients is reasonably good with less than 5% of doses missed. Educational effort must be addressed to IBD patients to avoid unjustified delayed doses.