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P412. Medication adherence in patients with active Crohn's disease: results from a large Italian multicenter survey

A. Orlando1, M. Principi2, M.L. Scribano3, G. Delle Fave4, P. Vernia5, P. Usai6, F. Castiglione7, G. Bodini8, A.F. Ciccaglione9, L. Biancone10, S. Saettone11, A. Michielan12, A. Iezzi13, A.C. Privitera14, 1Ospedali Riuniti Villa Sofia Cervello, Internal Medicine, Palermo, Italy, 2University of Bari, Gastroenterology, Bari, Italy, 3Azienda Ospedaliera San Camillo-Forlanini, Gastroenterology, Rome, Italy, 4Ospedale S. Andrea, Gastroenterology, Rome, Italy, 5University “La Sapienza”, Gastroenterology, Rome, Italy, 6University of Cagliari, Gastroenterology, Cagliari, Italy, 7University “Federico II”, Gastroenterology, Naples, Italy, 8Ospedale San Martino, Gastroenterology, Genoa, Italy, 9Ospedale Civile “S. Spirito”, Gastroenterology, Pescara, Italy, 10University of “Tor Vergata”, Gastroenterology, Rome, Italy, 11Ospedale S.S. Trinità, Gastroenterology, Borgomanero, Italy, 12University of Padua, Gastroenterology, Padua, Italy, 13AbbVie Inc, Global Medical Affairs, North Chicago, IL, United States, 14Azienda Ospedaliera per l'emergenza “Cannizzaro”, IBD Unit, Catania, Italy

Background

Medication adherence is one of the major determinants of treatment outcome in patients with chronic diseases, including inflammatory bowel diseases (IBD). In this context, several reports have estimated that non-adherence rates for IBD patients vary from 20% to 70% for short- and long-term therapies, respectively. A large multicenter survey was conducted in Italy in 38 referral centers, on adult subjects with a diagnosis of active Crohn's disease (CD), over a 12-month observation period between 2012 and 2013. Here we report the results of ad interim analysis performed at baseline, to identify factors related to treatment adherence in a large cohort of Italian patients with active CD.

Methods

Adults with active moderate-to-severe CD (Harvey–Bradshaw Index [HBI] ≥8) were prospectively recruited in 38 Italian IBD centres. Treatment adherence was assessed by the Medication Adherence Report Scale (MARS-5) self-reported questionnaire. Separate analyses were conducted by categorizing patients as fully or partially adherent on the basis of a MARS score of 25 or of less than 25, respectively. Results were correlated with clinical and demographical variables, with disease-related worries, evaluated by means of the Rating Form of Inflammatory Bowel Disease Patient Concerns (RFIPC) questionnaire, and with treatment satisfaction, evaluated by Treatment Satisfaction Questionnaire for Medication (TSQM). One-way analysis of variance (ANOVA), t-tests, and linear regression analyses were used to analyze data.

Results

552 patients (49% F, mean age 41±14 y, range 18–84 y) were recruited. Mean MARS score was 22±6. Patients with full adherence (=25) represented 44.5% of the total population, while partial adherence (<25) was reported by 55.5% of patients. High medication adherence was significantly associated with advanced age (p = 0.007), non-smoker or ex-smoker status (p = 0.009), and current biological therapy (p < 0.001). These results were confirmed by a linear multivariate regression analysis (p < 0.05). Low adherence was significantly associated with higher levels of disease-related concerns measured by RFIPC (p < 0.001) and low treatment satisfaction as measured by TSQM, with particular regard to low ease to use (p < 0.004). Furthermore, no differences in treatment adherence were found when comparing patients receiving infusional or subcutaneous biological therapy (p = 0.476).

Conclusion

This ad interim analysis confirms a high treatment adherence in half of the patients with moderate-to-severe active CD. Major determinants of high adherence were age, current biological therapy, and smoking status; low adherence was associated with disease-related concerns and treatment satisfaction.