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P313 Medication use and its perception by female inflammatory bowel disease patients.

S. Chetcuti Zammit1, M. Caruana1, K.H. Katsanos2, G.J. Mantzaris3, M. Cesarini4, U. Kopylov5, L. Zammit1, P. Ellul*1

1Mater Dei Hospital, Department of Gastroenterology, Msida, Malta, 2University of Ioannina School of Medical Sciences, Department of Internal Medicine, Medical School, Ioannina, Greece, 3Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals, Department of Gastroenterology, Athens, Greece, 4Sapienza University of Rome, Dipartimento di Medicina Interna e Specialità' Mediche, Rome, Italy, 5Sheba Medical Center, Department of Gastroenterology, Tel Hashomer, Israel

Medication% Number of patients
5-ASA66%
Steroids6.44%
Azathioprine22.3%
Infliximab20.2%
Adalimumab7.30%
Methotrexate1.29%
6-Mercaptopurine1.29%
Sulfasalazine1.29%

Background

Medication use in females with IBD of child-bearing age is challenging and has to be dealt with individually. Patients are young and want to take an active role in their own management. Some tend to stop medications before or during pregnancy. However, they fail to realize that most drugs are considered low risk for congenital anomalies. Maintaining remission with medical treatment outweighs the potential risks of adverse drug effects. Stopping medications carries the risk of flair ups during pregnancy.

Methods

This was a retrospective study were patients were recruited from 5 European centres. Female IBD patients were recruited and they were interviewed through a purposely designed questionnaire.

Results

233 patients were recruited (mean age 40 SD±11.9). The mean age of diagnosis was 31.4 years (SD±11.2). 85.5% of patients with ulcerative colitis (UC) had a Montreal classification of E2 or E3. 64.7% of Crohn's disease (CD) patients, had non-stricturing and non-penetrating disease.

4.3% were not compliant to treatment. Reasons given included, well-being, long standing remission, fear of medications, problems with employers and suppositories and enemas being uncomfortable.

15.0% thought that all medications should be stopped during pregnancy. 63.1% of patients were unsure and 12% claimed that only some medications should be stopped. 5-ASA was considered as a very safe medication by more than 99% of patients.

Medications were stopped by the patient’s doctor in 13.9%. This consisted of biologics stopped in the third trimester (2.7%), 5-ASA (9.4%), methotrexate (0.9%) and prednisolone (0.9%). Medications were added by the doctor in 3.9% mainly by adding 5-ASA, folic acid, azathioprine and prednisolone. Dose of steroids and 5-ASA were increased in 2.6%. There was no reported reduction in dose of medications. 1.7% stopped medications on their own accord. Reasons given included fear of harm to the baby and being in remission.

26.6% patients were uncertain if patients with IBD could breast feed. 40.8% thought that they could not breast feed. 54.5% breast fed their babies. In those who did not breastfeed, only 10.7% did not do so because of the medications that they were having. The rest did not breastfeed due to fear and misconceptions about IBD and breastfeeding.

Conclusion

Unfortunately, 5-ASA is still regarded as unsafe during pregnancy by some physicians. There is still lack of awareness amongst patients about why patients should continue medications during pregnancy. More awareness is needed about breast feeding in patients with IBD.