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Published in:

01-12-2008 | Review Article

Strategies to Improve Adherence and Outcomes in Patients with Ulcerative Colitis

Author: Dr Sunanda V. Kane

Published in: Drugs | Issue 18/2008

Abstract

This review examines studies of patient adherence to 5-aminosalicylic acid therapy conducted outside the context of a controlled therapy trial, considers the reasons why patients do not adhere to their medication and its consequences, and interventions to improve adherence and disease outcomes. Non-adherence in the inflammatory bowel disease population tends to mirror other chronic illnesses, in the range of 40–60%. Factors that appear to affect adherence include younger age, single status, heavy pill burden, perception of lack of benefit and feeling uninformed about the effect of medication. Three important outcomes of non-adherence include increased risk for disease activity, increased healthcare costs and the possible increased risk of dysplasia/colorectal cancer. Strategies to improve adherence include patient education and ‘health literacy’, along with discussing patient misperceptions and fears on an individual basis, decreasing the daily regimen and switching to high-dose formulations, and incorporating patient self-management techniques into practice.

The use of trade names is for identification purposes only and does not imply endorsement.

Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 2004; 99: 1371–85PubMedCrossRef

Qureshi AI, Cohen RD. Mesalamine delivery systems: do they really make much difference? Adv Drug Deliv Rev 2005; 57: 281–302PubMedCrossRef

Rogler G, Brand K, Vogl D, et al. Nuclear factor kappaB is activated in macrophages and epithelial cells of inflamed intestinal mucosa. Gastroenterology 1998; 115: 357–69PubMedCrossRef

Carter MJ, Lobo AJ, Travis SP. Guidelines for the management of inflammatory bowel disease in adults. Gut 2004; 53: V1–16PubMedCrossRef

Miller NH. Compliance with treatment regimens in chronic asymptomatic diseases. Am J Med 1997; 102: 43–9PubMedCrossRef

Riley SA, Mani V, Goodman MJ, et al. Why do patients with ulcerative colitis relapse? Gut 1990; 31: 179–83PubMedCrossRef

van Hees PA, van Tongeren JH. Compliance to therapy in patients on a maintenance dose of sulfasalazine. J Clin Gastroenterol 1982; 4: 333–6PubMedCrossRef

Stone MA, Mayberry JF, Baker R. Prevalence and management of inflammatory bowel disease: a cross-sectional study from central England. Eur J Gastroenterol Hepatol 2003; 15(12): 1275–80PubMedCrossRef

Kane SV, Cohen RD, Aikens JE, et al. Prevalence of nonadherence with maintenance mesalamine in quiescent ulcerative colitis. Am J Gastroenterol 2001; 96: 2929–33PubMedCrossRef

10.

Hall NJ, Rubin GP, Hungin AP, et al. Medicaiton beliefs among patients with inflammatory bowel disease who report low quality of life: a qualitative study [letter]. BMC Gastroenterol 2007; 7: 20PubMedCrossRef

11.

Moshkovska T, Stone M, Baker R, et al. Qualitative investigation of patient adherence to 5-aminosalicylic acid therapy in patients with ulcerative colitis. Inflamm Bowel Dis 2008; 14(6): 763–8PubMedCrossRef

12.

Kane SV. Systematic review: adherence issues in the treatment of ulcerative colitis. Aliment Pharmacol Ther 2006; 23: 577–85PubMedCrossRef

13.

Ediger JP, Walker JR, Graff L, et al. Predictors of medication adherence in inflammatory bowel disease. Am J Gastroenterol 2007; 102: 1–10CrossRef

14.

Cerveny P, Bortlik M, Kobena A, et al. Nonadherence in inflammatory bowel disease: results of factor analysis. Inflamm Bowel Dis 2007 Oct; 13(10): 1244–9PubMedCrossRef

15.

Magowan S, Kane S, Lange J. 5-ASA prescription refill rates of ulcerative colitis are independent of formulation and dosing regimens [abstract]. Am J Gastroenterol 2006; 101: S447

16.

Kane S, Magowan S, Accortt N, et al. Predictors of 5-ASA prescription persistence in patients with ulcerative colitis [abstract no. M1033]. Gastroenterology 2007; 132: A347

17.

Kane S, Magowan S, Accortt N, et al. Predictors of 5-ASA prescription persistence during the chronic phase in patients with ulcerative colitis [abstract]. Am J Gastroenterol 2007; 102: A941CrossRef

18.

Kane SV, Aikens J, Huo D, et al. Medication adherence is associated with improved outcomes in patients with quiescent ulcerative colitis. Am J Med 2003; 113: 39–42CrossRef

19.

Kane S, Shaya F. Medication non-adherence is associated with increased medical health care costs. Dig Dis Sci 2008 Apr; 53(4): 1020–4PubMedCrossRef

20.

Moody GA, Jayanthi V, Probert CS, et al. Long-term therapy with sulphasalazine protects against colorectal cancer in ulcerative colitis: a retrospective study of colorectal cancer risk and compliance with treatment in Leicestershire. Eur J Gastroenterol Hepatol 1996; 8: 1179–83PubMedCrossRef

21.

Pinczowski D, Ekbom A, Baron J, et al. Risk factors for colorectal cancer in patients with ulcerative colitis: a case-control study. Gastroenterology 1994; 107: 117–20PubMed

22.

Eaden J, Abrams K, Ekbom A, et al. Colorectal cancer prevention in ulcerative colitis: a case-control study. Aliment Pharmacol Ther 2000; 14: 145–53PubMedCrossRef

23.

Ullman T, Croog V, Itzkowitz S, et al. Preventing neoplastic progression in ulcerative colitis: role of mesalamine [abstract]. Gastroenterology 2003; 124(4): S1662CrossRef

24.

Rubin DT, Losavio A, Yadron N, et al. Aminosalicylate therapy in the prevention of dysplasia and colorectal cancer in ulcerative colitis. Clin Gastroenterol Hepatol 2006 Nov; 4(11): 1346–50PubMedCrossRef

25.

Bernstein C, Metghe C, Blanachard JF. Does the use of 5-aminosalicylates in inflammatory bowel disease prevent the development of colorectal cancer [abstract]? Gastroenterology 2003; 124(4): A280

26.

Velayos F, Terdiman J, Walsh JM. Effect of 5-aminosalicylate use on colorectal cancer and dysplasia risk: a systematic review and metaanalysis of observational studies. Am J Gastroenterol 2005 Jun; 100(6): 1345–53PubMedCrossRef

27.

Sewitch MJ, Abrahamowicz M, Barkun A, et al. Patient nonadherence to medication in inflammatory bowel disease. Am J Gastroenterol 2003; 98: 1535–44PubMedCrossRef

28.

Davis TC, Wolf MS, Bass III PF, et al. Literacy and misunderstanding prescription drug labels. Ann Intern Med 2006; 145: 887–94PubMed

29.

Kripalani S, Yao X, Haynes RB. Interventions to enhance medication adherence in chronic medical conditions: a systematic review. Arch Intern Med 2007; 167: 540–50PubMedCrossRef

30.

Dickinson RJ, King A, Wight DG, et al. Is continuous sulfasalazine necessary in the management of patients with ulcerative colitis? Results of a preliminary study. Dis Colon Rectum 1985; 28: 929–30PubMedCrossRef

31.

Bardazzi G, d’Albasio G, Bonamoni AG, et al. Intermittent versus continuous 5-aminosalicylic acid treatment for maintaining remission in ulcerative colitis. Ital J Gastroenterol 1994; 26(7): 334–7PubMed

32.

Ardizzone S, Petrillo M, Imbesi V, et al. Is maintenance therapy always necessary for patients with ulcerative colitis in remission? Aliment Pharmacol Ther 1999; 13(3): 373–9PubMedCrossRef

33.

Brunner M, Assandri R, Kletter K, et al. Gastrointestinal transit and 5-ASA release from a new mesalazine extended-release formulation. Aliment Pharmacol Ther 2003; 17: 395–402PubMedCrossRef

34.

Lichtenstein GR, Kamm MA, Boddu P, et al. Effect of once- or twice-daily MMX mesalamine (SPD476) for the induction of remission of mild to moderately active ulcerative colitis. Clin Gastroenterol Hepatol 2007; 5: 95–102PubMedCrossRef

35.

Sandborn WJ, Kamm M, Lichtenstein GR, et al. MMX Multi Matrix System mesalazine for the induction of remission in patients with mild-to-moderate ulcerative colitis: a combined analysis of two randomized, double-blind, placebo-controlled trials. Aliment Pharmacol Ther 2007 Jul 15; 26(2): 205–15PubMedCrossRef

36.

Hanauer S, Sandborn W, Dellaire K, et al. Delayed-release oral mesalamine 4.8 g/day (800 mg tablets) compared to 2.4 g/day (400 mg tablets) for the treatment of mildly to moderately active ulcerative colitis: the ASCEND I trial. Can J Gastroenterol 2007 Dec; 21(12): 827–34PubMed

37.

Hanauer S, Sandborn W, Kornbluth A, et al. Delayed-release oral mesalamine at 4.8 g/day (800 mg tablet) for the treatment of moderately active ulcerative colitis: the ASCEND II trial. Am J Gastroenterol 2005; 100: 2478–85PubMedCrossRef

38.

Ferring Pharmaceuticals. Pentasa once daily in ulcerative colitis for maintenance of remission [ClinicalTrials.gov identifier NCT00209300]. US National Institutes of Health, ClinicalTrials.gov [online]. Available from URL: http://www.clinicaltrials.gov [Accessed 2008 Jun 9]

39.

Kane S, Huo D, Magnanti K. A pilot feasibility study of once daily versus conventional dosing mesalamine for maintenance of ulcerative colitis. Clin Gastroenterol Hepatol 2003; 1: 170–3PubMedCrossRef

40.

Kane S, Holderman W, Jacques P, et al. Once daily versus conventional dosing of ph-dependent mesalamine long-term in the maintenance of quiescent ulcerative colitis: preliminary results from a randomized trial. Patient Preferences and Adherence 2008; 2: 253–8CrossRef

41.

Wong JM, Wei SC. Efficacy of Pentasa tablets for the treatment of inflammatory bowel disease. J Formos Med Assoc 2003; 102: 613–9PubMed

42.

Sandborn WJ, Kamm MA, Lichtenstein GR, et al. SPD476, a novel, high-strength 5-ASA formulation induces remission of active, mild-to-moderate ulcerative colitis in subjects that are switched from low-dose oral 5-ASA therapy or are 5-ASA naive: an analysis of pooled data from two phase III studies [abstract no. T1139]. Gastroenterology 2007; 130 (4 Suppl. 2): A–482

43.

Drossman DA, Leserman K, Li Z, et al. The rating form of IBD patient concerns: a new measure of health status. Psychosom Med 1991; 53: 701–12PubMed

44.

Martin A, Leone L, Fries W, et al. What do patients want to know about their inflammatory bowel disease. Ital J Gastroenterol 1992; 24(8): 477–80PubMed

45.

Levy R, Feld AD. Increasing patient adherence to gastroenterology treatment and prevention regimens. Am J Gastroenterol 1999; 94: 1733–42PubMedCrossRef

46.

Nobel LM. Doctor-patient communication and adherence to treatment. In: Myers LB, Midence K, editors. Adherence to treatment in medical conditions. New York: Harwood Academic Publishers, 1998: 51–82

47.

Sewitch MJ, Abrahamowicz M, Barkun A, et al. Patient nonadherence to medication in inflammatory bowel disease. Am J Gastroenterol 2003; 98(7): 1535–44PubMedCrossRef

48.

Robinson A, Thompson DG, Wilkin D, et al. Guided self-management and patient-directed follow-up of ulcerative colitis: a randomized trial. Lancet 2001; 358(9268): 976–81PubMedCrossRef

Title: Strategies to Improve Adherence and Outcomes in Patients with Ulcerative Colitis
Author: Dr Sunanda V. Kane
Publication date: 01-12-2008
Publisher: Springer International Publishing
Published in: Drugs / Issue 18/2008
Print ISSN: 0012-6667
Electronic ISSN: 1179-1950
DOI: https://doi.org/10.2165/0003495-200868180-00006

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Strategies to Improve Adherence and Outcomes in Patients with Ulcerative Colitis

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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