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P496 Prevalence and reasons for drug non-adherence in a European cohort of ulcerative colitis patients: The UCandME survey

S. Vavricka1, R. Hofmann2, X. Guillaume3, G. Rogler1, L. Peyrin-Biroulet4, E. Safroneeva5, A. Schoepfer*6

1University of Zurich, Gastroenterology and Hepatology, Zurich, Switzerland, 2Tillotts, Gastroenterology, Rheinfelden, Switzerland, 3Kantar Health , Research, Montrouge, France, 4CHU de Nancy, Department of Gastroenterology, Vandoeuvre-les-Nancy, France, 5University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland, 6Centre Hospitalier Universitaire Vaudois, Gastroenterology and Hepatology, Lausanne, Switzerland

Background

Non-adherence to medical treatment represents a major issue in patients with inflammatory bowel disease (IBD). Studies assessing the prevalence and associated causes of non-adherence in patients with ulcerative colitis (UC) in Europe remain scarce. We aimed to assess the prevalence and specific reasons for non-adherence in a prospective cohort of mild-to-moderate UC patients.

Methods

Five European UC experts developed a questionnaire that was administered to UC patients in 6 European countries (Sweden, Norway, Finland, Denmark, United Kingdom, and Spain). The questionnaire consists of 54 questions, including several questions addressing specifically adherence to UC medication. Patients completed the questionnaire online via a secured website. The Morisky score was calculated to evaluate drug adherence.

Results

A total of 372 UC patients completed the survey (mean age 42.3 ± 13.9 years, 50% females, mean disease duration 10 years). Current disease location was in 24% proctitis, 45% left-sided colitis, 22% pancolitis, and in 9% unknown. At time of questionnaire completion, 47% of patients were on a specific diet, and 31% took alternative medicine to treat their UC. Nine out of 10 of patients were concerned about the preservation of their health, 68% believed in preventive treatments, and 66% thought they "should do more to be healthy". Based on the Morisky scale, 60% of patients were identified to have a low adherence, 33% had medium adherence, and only 7% had high adherence. In the last three months before the survey, 36% had never forgotten to take their medication, 30% forgot it once to two times, 18% forgot it 3-5 times, and 16% forgot it 6 and more times. The following reasons for drug non-adherence were identified: 51% of patients "forgot to take the drugs", 22% of patients "found it inconvenient to take the drugs", 21% stopped the drugs because of feeling better, 20% wanted to prevent drug-related side effects, 19% feared side-effects, 15% feared addiction to drugs for UC treatment, 14% noted that the drugs to treat UC were too expensive, 9% thought they were not in need of the drugs, 5% had doubts that the drugs would work, and 3% indicated not to know how to use the drugs (multiple answers possible).

Conclusion

Non-adherence to drugs is frequent in patients with mild to moderate UC, only 7% of them being highly adherent in this European survey. The most frequent reason for non-adherence was "forgetting to take the drug". Interventions to target patient adherence should take into account their specific health beliefs and offer a reminder system for regular drug intake.