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P654 Factors associated with non-adherence to medical therapy in inflammatory bowel disease

M. L. De Castro*1, N. Martínez2, A. Martín2, L. Sanromán1, M. Figueira1, V. Hernández1, J. R. Pineda1, J. Martínez-Cadilla1, S. Pereira1, V. Del Campo3, J.-I. Rodríguez-Prada1

1Hospital Alvaro Cunqueiro. Complexo Hospitalario Universitario de Vigo.CHUVI, Gastroenterology, Vigo, Spain, 2Hospital Alvaro Cunqueiro. Complexo Hospitalario Universitario de Vigo.CHUVI, Hospital Pharmacy, Vigo, Spain, 3Hospital Alvaro Cunqueiro. Complexo Hospitalario Universitario de Vigo.CHUVI, Epidemiology, Vigo, Spain

Background

Non-adherence to medication is a medical problem in patients with inflammatory bowel disease, and most studies have reported non-adherence rates of 30%–45%. Many demographic, clinical, and treatment variables have not been consistently associated with non-adherence at the moment, but strategies that have been used to measure patient adherence to therapy are very heterogeneous.

Methods

All consecutive patients with non-active Crohn’s disease (CD) or ulcerative colitis (UC) visited in the IBD outpatient clinic of the Hospital Universitary of Vigo (Spain) from October 2014 to April of 2015 were invited to participate in this prospective study. Patients who consented answered anonymously the Beliefs About Medication Questionnaire (BMQ), and their pharmacy refills were reviewed from the previous 3 months to calculate Medication Possession Ratio (MPR) as the proportion (or percentage) of days’ supply obtained during a specified time period or over a period of refill intervals. Demographic, clinical, and treatment factors were reviewed. Low adherence was defined as a MPR < 0.8.

Results

In total, 203 patients were enrolled, with 121 UC and 82 CD; 50.7% male, 149 (73.8%) on monotherapy and 53 (26.2%) on polytherapy for IBD. At baseline, 64.9% were on 5-aminosalicylic (5-ASA); 46.5% on an immunomodulator; and 15.8% on a biologic drug. A MPR < 0.8 score identified 36% patients as low adherents. No significant association was found with demographic variables (gender, age, marriage, employment, or level of education); clinical variables (type of IBD, time from diagnosis, and disease activity); treatment variables (concomitant medication and number of daily doses of IBD medication); habits (tobacco, alcohol, and drugs); or hospital care (number of previous visits). Low adherence was associated to higher values or C-reactive protein (p = 0,005) but not with an adverse clinical course in the previous 3 months. Medication beliefs (potential adverse effects of IBD medication) were related to low adherence, as well (p = 0.03).

Conclusion

Demographic, clinical, and treatment variables were not consistently associated with non-adherence; however, beliefs about medications were associated with non-adherence. Further, C-reactive protein value was higher in non-adherent patients; however, clinical outcomes in the 3 previous months were similar.