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* = Presenting author

P344 Non-adherence to medical therapy is associated with hospitalisations and the development of active disease in inflammatory bowel disease

M. Severs*1, H. H. Fidder1, M.-J. Mangen2, M. E. van der Valk1, M. van der Have1, A. A. van Bodegraven3, 4, C. H. M. Clemens5, G. Dijkstra6, J. M. Jansen7, D. J. de Jong8, N. Mahmmod9, P. C. van de Meeberg10, A. E. van der Meulen- de Jong11, M. Pierik12, C. Y. Ponsioen13, M. J. L. Romberg- Camps3, P. D. Siersema1, J. R. Vermeijden14, J. van der Woude15, P. N. Zuithoff16, B. Oldenburg1

1University Medical Centre Utrecht, Gastroenterology and Hepatology, Utrecht, Netherlands, 2University Medical Centre Utrecht, Julius Centre for Health Sciences and Primary Care, Utrecht, Netherlands, 3ORBIS medical Centre, Gastroenterology and Hepatology, Sittard, Netherlands, 4VU medical Centre, Gastroenterology and Hepatology, Amsterdam, Netherlands, 5Diaconessenhuis, Gastroenterology and Hepatology, Leiden, Netherlands, 6University Medical Centre Groningen, Gastroenterology and Hepatology, Groningen, Netherlands, 7Onze Lieve Vrouwe Gasthuis, Gastroenterology and Hepatology, Amsterdam, Netherlands, 8University Medical Centre St. Radboud, Gastroenterology and Hepatology, Nijmegen, Netherlands, 9Antonius Hospital, Gastroenterology and Hepatology, Nieuwegein, Netherlands, 10Slingeland Hospital, Gastroenterology and Hepatology, Doetinchem, Netherlands, 11Leiden University Medical Centre, Gastroenterology and Hepatology, Leiden, Netherlands, 12University Medical Centre Maastricht, Gastroenterology and Hepatology, Maastricht, Netherlands, 13Academic Medical Centre Amsterdam, Gastroenterology and Hepatology, Amsterdam, Netherlands, 14Meander Medical Centre, Gastroenterology and Hepatology, Amersfoort, Netherlands, 15Erasmus Medical Centre, Gastroenterology and Hepatology, Rotterdam, Netherlands, 16University Medical Centre Utrecht, Julius Centre for Health Sciences and Primary Care, Utrecht, Netherlands

Background

Non-adherence to medical therapy might invalidate efficacy of medication in inflammatory bowel disease (IBD) patients. We aimed to identify factors associated with non-adherence in IBD, and examine changes in adherence and associated disease outcomes over time.

Methods

A large Dutch cohort of adult patients with Crohn’s disease (CD) and ulcerative colitis (UC) was prospectively followed for more than 2 years. Data on the disease course and IBD-specific healthcare use was collected by 3-monthly questionnaires. Medication adherence was self-assessed during follow-up by a visual analogue scale (VAS), ranging from 0–100%. Patients with rates < 80% were considered non-adherent. We used a generalised linear mixed model to identify patient- and disease-related factors associated with non-adherence (employing backwards selection); analyse disease outcomes (ie, active disease, disease activity scores (short-CDAI for CD and MTWSI for UC), surgeries, hospitalisations, and emergency department presentations) of patients who developed non-adherent behaviour after 3 months of follow-up; and analyse whether non-adherence was associated with subsequent failure of medical treatment, corrected for disease severity.

Results

In total, 2 612 patients (1 558 CD and 1 054 UC) were evaluated, of whom 77.6% used medication and 16% was non-adherent. Non-adherence was not different between CD and UC patients, and was most frequently observed in patients using 5-ASA compounds (16.9%) and in patients with rectally administrated medication (20.1%). Non-adherence was associated with lower age (p = 0.01), rectal blood loss (p = 0.06), and negative perceptions towards benefits of medical therapy and received healthcare (p < 0.01 and p = 0.07, respectively). UC patients with a declining medication adherence more often developed active disease within a follow-up of 6 months (odds ratio [OR] 1.49, p = 0.03), with already increasing disease activity levels at 3 months (OR 1.79, p = 0.10). A declining medication adherence in both CD and UC patients was associated with hospitalisations and emergency department presentations after 3 months (OR 1.99, p < 0.01 and OR 2.26, p = 0.03, respectively). In CD patients, non-adherence was associated with subsequent failure of thiopurine- and anti-TNF treatment after 3 months (OR 2.41, p < 0.01 and OR 1.49, p = 0.04, respectively).

Conclusion

Non-adherence to medical therapy is associated with a more severe disease course in IBD. Non-adherent UC patients more often develop active disease; non-adherent UC and CD patients are more often hospitalised and presented to the emergency department.