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P597. Adherence to methotrexate (MTX) in inflammatory bowel disease (IBD) patients: an observational multicenter study

D. Laharie1, V. Billioud2, X. Roblin3, J. Filippi4, A. Ayroles5, M. Capdepont5, L. Peyrin-Biroulet2, 1CHU de Bordeaux, Gastroentérologie, Pessac, France, 2CHU de Nancy, France, 3CHU de Saint-Etienne, France, 4CHU de Nice, France, 5CHU de Bordeaux, France

Background

In IBD patients, low adherence to treatment is associated with poor outcomes and increased health costs. No data concerning adherence to MTX in IBD is available so far. The aim of the present study was to determine the rate of adherence to MTX in IBD and to identify factors associated with low adherence to the drug.

Methods

From March 2009 to March 2011, IBD patients treated with MTX were consecutively recruited in an observational prospective multicenter study conducted in four French tertiary centers if they received the drug for at least 12 weeks. Patients were asked through an anonymous auto-questionnaire concerning adherence to MTX within the last three months.

Results

Eighty-seven patients (55 men, median age: 44 [range: 17–78] years) were enrolled: 63 with Crohn's disease (CD) and 24 with ulcerative colitis (UC). Indications for MTX were refractory luminal CD (n = 46), fistulising CD (n = 11), extra-intestinal manifestations (n = 6) and refractory UC (n = 24). Weekly dose and median duration of MTX were 25 [7.5–25] mg and 50 [12–862] weeks, respectively; drug was administered sub-cutaneously in 64%. Forty-six (53%) patients have delayed (n = 38–44%) and/or missed (n = 21–24%) at least one MTX injection. In multivariate analysis, the sole factor associated with non-adherence was an age below 44 years (OR: 2.86 [95% CI: 1.17–7.03] and a center effect was observed (P = 0.04).

Conclusion

Low adherence to MTX was observed in nearly half of IBD patients and was associated with an age below 44 years. As described with other parenteral treatments of IBD, low observance to MTX has to be taken into account mainly in young patients.