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P315 Effect of age on beliefs about and adherence to medications in patients with inflammatory bowel disease: results from the ALIGN study

P. Michetti*1, L. Peyrin-Biroulet2, M. S. Silverberg3, E. Louis4, J. Weinman5, J. Sommer6, J. Petersson7, B. Pappalardo7, P. Nurwakagari8

1IBD Centre La Source-Beaulieu, Lausanne, Switzerland, 2Inserm U954 and Department of Gastroenterology, Université de Lorraine, Vandoeuvre-les-Nancy, France, 3Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, University of Toronto, Toronto, Canada, 4CHU de Liège et Université de Liège, Liège, Belgium, 5Institute of Pharmaceutical Sciences & Institute of Psychiatry, King’s College, London, United Kingdom, 6GKM Gesellschaft für Therapieforschung mbH, Munich, Germany, 7AbbVie Inc., North Chicago, Illinois, United States, 8AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany

Background

Previous studies have revealed conflicting results about the effect of age on medication adherence in patients (pts) with inflammatory bowel disease (IBD).1 This sub-analysis from the ALIGN study explored the effect of age on beliefs about and adherence to current systemic medication, including tumour necrosis factor inhibitors (TNFi), in a large cohort of pts with Crohn’s disease (CD) and ulcerative colitis (UC).

Methods

The global, cross-sectional ALIGN study determined pts’ beliefs about and adherence to systemic therapies in >7 000 pts with 6 immune-mediated inflammatory diseases, including CD and UC. Treating physicians administered validated questionnaires, including 4-item Morisky Medication Adherence Scale (MMAS-4), and Beliefs about Medicines Questionnaire (BMQ), to pts during a routine visit. Pts were categorised according to median age; results for adherence to and beliefs about current medication were compared between the groups. Factors associated with high adherence and treatment necessity beliefs and concerns were derived from multiple regression analysis.

Results

In total, 1 146 pts with CD (median age, 35 yr; interquartile range [IQR], 27–46 yr) and 613 pts with UC (median age, 41 yr, IQR, 31–54 yr) were analysed. Race, sex, disease severity, and response to current treatment were similar between the age groups; as expected, disease and treatment duration were significantly longer amongst older vs younger pts (Table 1). Significantly, a higher number of older pts had high adherence ratings to treatment vs younger pts, especially when comparing the 25% and 75% quantiles (Table 1). The mean BMQ Necessity score, but not concerns, was significantly higher in older pts, especially when comparing the 25% and 75% quantiles (Table 1). In multiple regression analyses, a 1-year increase in age was associated with a 6% (CD; OR = 1.06; 95% CI, 1.04–1.09) and 8% (UC; OR = 1.08; 95% CI, 1.05–1.12)-higher likelihood of full adherence to current systemic/TNFi therapy, and significantly higher medication necessity beliefs (but not concerns) as assessed by BMQ. Brief Illness Perception Questionnaire data were analysed but did not significantly affect age differences in necessity beliefs.

Table 1. Patient-Reported Characteristics, Adherence to Systemic Therapy, and BMQ-Specific Necessity and Concerns Ratings by Age Groups

Conclusion

The data from this large cross-sectional study indicate that younger IBD pts are at higher risk of not adhering to their medication than older pts. The higher adherence amongst older pts might be due to their unwillingness to take risks with their health.

Reference

[1] Vangeli E, et al, (2015), A systematic review of factors associated with non-adherence to treatment for immune-mediated inflammatory diseases, Adv Ther, Epub ahead of print