Background/Aims Medication non-adherence is common in inflammatory bowel diseases (IBD). The short-term consequences of non-adherence include increased disease relapse but the long-term impact upon patients in terms of daily functional impairment are less well characterized. Identifying negative outcomes, such as disability, may encourage adherence.
Methods Consecutive ambulatory IBD subjects completed the Medication Adherence Rating Scale (MARS; non-adherence defined as ≤16), Inflammatory Bowel Diseases Disability Index (IBD-DI; disability: <3.5) and Beliefs about Medicines Questionnaire (high necessity/concerns: ≥16). The primary outcome was the association between medication non-adherence and disability. Secondary outcomes were the predictors of these outcomes.
Results A total of 173 subjects on IBD maintenance medications were recruited (98 Crohn’s disease, 75 ulcerative colitis: median IBD-DI, –5.0; interquartile range [IQR], –14.0 to 4.0 and median MARS, 19.0; IQR, 18 to 20) of whom 24% were non-adherent. Disability correlated significantly with medication non-adherence (r=0.38, P<0.0001). Median IBD-DI for non-adherers was significantly lower than adherers (–16.0 vs. –2.0, P<0.0001). Predictors of disability included female sex (P=0.002), previous hospitalization (P=0.023), management in a referral hospital clinic (P=0.008) and medication concerns (P<0.0001). Non-adherence was independently associated with difficulty managing bowel movements (odds ratio [OR], 3.71; 95% confidence interval [CI], 1.50–9.16, P=0.005), rectal bleeding (OR, 2.69; 95% CI, 1.14–6.36; P=0.024) and arthralgia/arthritis (OR, 2.56; 95% CI, 1.11–5.92; P=0.028).
Conclusions Medication non-adherence was associated with significantly increased disability in IBD. Female gender, higher disease severity and medication concerns were additional predictors of disability.
Citations
Citations to this article as recorded by
Optimizing 5-aminosalicylate for moderate ulcerative colitis: expert recommendations from the Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition Filiz Akyüz, Yoon Kyo An, Jakob Begun, Satimai Aniwan, Huu Hoang Bui, Webber Chan, Chang Hwan Choi, Nazeer Chopdat, Susan J Connor, Devendra Desai, Emma Flanagan, Taku Kobayashi, Allen Yu-Hung Lai, Rupert W Leong, Alex Hwong-Ruey Leow, Wai Keung Leung, Ju Intestinal Research.2025; 23(1): 37. CrossRef
Understanding Medication Nonadherence in Crohn’s Disease Patients: A Qualitative Evaluation Robert E Brady, Jessica K Salwen-Deremer, Natalie C Tunnell, Michael W Winter Inflammatory Bowel Diseases.2024; 30(11): 2046. CrossRef
Attitudes to medication and effects of IBD nursing service among patients with inflammatory bowel disease in Taiwan Chen‐Ta Yang, Tsui‐Chun Hsu, Yang‐Yuan Chen, Siou‐Ping Huang, Hsu‐Heng Yen Advances in Digestive Medicine.2024; 11(3): 162. CrossRef
COMPLIANCE AND QUALITY OF LIFE OF PATIENTS WITH INFLAMMATORY BOWEL DISEASES R.J. JAMOLOVA, D.K. MUKHABBATOV, D.T. RAKHMONOV, S.G. ALI-ZADE AVICENNA BULLETIN.2024; 26(1): 76. CrossRef
High refill-adherence to adalimumab is associated with low disease activity in patients with inflammatory bowel disease Esma H. San, Angelique Egberts, Caroline W. Th. van Dijck - van Boetzelaer, Rachel L. West, Erwin C. Vasbinder European Journal of Clinical Pharmacology.2024; 80(7): 1089. CrossRef
MMX mesalamine in ulcerative colitis: Major advantages towards classical mesalamine formulations Ferdinando D'Amico, Francesca Lusetti, Laurent Peyrin-Biroulet, Silvio Danese Digestive and Liver Disease.2024; 56(9): 1425. CrossRef
Motivational Interviewing as a Strategy to Improve Adherence in IBD Treatment: An Integrative Review Amidst COVID-19 Disruptions Caterina Mercuri, Maria Catone, Vincenzo Bosco, Assunta Guillari, Teresa Rea, Patrizia Doldo, Silvio Simeone Healthcare.2024; 12(12): 1210. CrossRef
The economic impact of suboptimal treatment and treatment switch among patients with Crohn’s disease treated with a first-line biologic – A US retrospective claims database study Patrick Gagnon-Sanschagrin, Myrlene Sanon, Mikhaïl Davidson, Cynthia Willey, Sumesh Kachroo, Timothy Hoops, Dominik Naessens, Annie Guerin, Martin Cloutier Journal of Medical Economics.2024; 27(1): 931. CrossRef
A Practical Approach to Identify Non-Adherence to Mesalamine Therapy in Inflammatory Bowel Disease Filippo Vernia, Giorgia Burrelli Scotti, Raffaele Borghini, Mario Muselli, Stefano Necozione, Giovanni Moretta, Lorenza Scurti, Giuseppe Donato Gastroenterology Insights.2024; 15(3): 754. CrossRef
Use of Complementary and Alternative Therapies in People with Inflammatory Bowel Disease Laura Frank, Kelly Lambert International Journal of Environmental Research and Public Health.2024; 21(9): 1140. CrossRef
Obstacles to Medication Adherence for Patients with Inflammatory Bowel Disease: A Qualitative Study in East China Fen Xu, Jingjing Xing, Mingna Fan, Zhiping Zhu, Yan Chen, Wen Hu, Yunxian Zhou Patient Preference and Adherence.2024; Volume 18: 2481. CrossRef
A Retrospective Cohort Study of Clinical Features and Treatment Patterns With Ustekinumab in Patients With Crohn Disease Utilizing a Health Care Database in Japan Yanfang Liu, Choo Hua Goh, Hong Qiu, Kuan-Chih Huang, Hsingwen Chung, Carine Saadoun Annals of Pharmacotherapy.2023; 57(9): 1053. CrossRef
Development and implementation of a laboratory monitoring dashboard to reduce treatment gaps in inflammatory bowel disease Miranda Kozlicki, Bridget Lynch, Tony Donoho, Patrick Nichols, Autumn D Zuckerman American Journal of Health-System Pharmacy.2023; 80(Supplement): S55. CrossRef
Efficacy, Safety, Patient Experience, and Tolerability of Risankizumab Administered by On-Body Injector for Moderate to Severe Crohn’s Disease Edward V. Loftus, Jenny Griffith, Ezequiel Neimark, Alexandra Song, Kori Wallace, Sujani Nannapaneni, Ji Zhou, Rachel Byrne, Kristina Kligys, Yinuo Pang, Xiaomei Liao, Jasmina Kalabic, Marla Dubinsky Advances in Therapy.2023; 40(5): 2311. CrossRef
Development and Validation of a Remote Monitoring Tool for Assessment of Mild, Moderate, and Severe Infections in Inflammatory Bowel Disease Ashkan Rezazadeh Ardabili, Dirk van Esser, Dion Wintjens, Mia Cilissen, Debbie Deben, Zlatan Mujagic, Fritzi Russ, Laurents Stassen, Adriaan A Van Bodegraven, Dennis Wong, Bjorn Winkens, Daisy Jonkers, Mariëlle Romberg-Camps, Marie J Pierik Journal of Crohn's and Colitis.2023; 17(7): 1079. CrossRef
Factors contributing to flares of ulcerative colitis in North India- a case-control study Vishavdeep Singh Rana, Gaurav Mahajan, Amol N. Patil, Anupam K. Singh, Vaneet Jearth, Aravind Sekar, Harjeet Singh, Atul Saroch, Usha Dutta, Vishal Sharma BMC Gastroenterology.2023;[Epub] CrossRef
An education‐based telehealth group improves the management and clinical outcomes of patients with inflammatory bowel disease in China (THEIM study) Jian Kang, Juan Su, Jing Wang, Haixia Ren, Anning Yin, Jiao Li, Qian Zhou, Yang Wang, Peng Zhu, Liping Zou, Wei Wang, Zhishun Tang, Weiguo Dong, Yijuan Ding, Ping An United European Gastroenterology Journal.2023; 11(10): 960. CrossRef
Delaying an infliximab infusion by more than 3 days is associated with a significant reduction in trough levels but not with clinical worsening Zohar Ben-Shatach, Tomer Ziv-Baran, Ella Fudim, Miri Yavzori, Orit Picard, Asaf Levartovsky, Limor Selinger, Batia Weiss, Uri Kopylov, Rami Eliakim, Bella Ungar Therapeutic Advances in Gastroenterology.2022;[Epub] CrossRef
Medication Adherence and Its Influencing Factors Among Inflammatory Bowel Disease Patients in China Fen Xu, Juping Tang, Zhiping Zhu, Yan Chen, Wen Hu, Sha Lu, Yunxian Zhou, Ding Lin International Journal of General Medicine.2022; Volume 15: 4141. CrossRef
Indicators of Suboptimal Treatment and Associated Healthcare Costs Among Patients With Crohn’s Disease Initiated on Biologic or Conventional Agents Dominic Pilon, Zhijie Ding, Erik Muser, Ameur M Manceur, Maude Vermette-Laforme, Marie-Hélène Lafeuille, Patrick Lefebvre Crohn's & Colitis 360.2022;[Epub] CrossRef
Medication adherence in women with IBD of childbearing age likely associated with disease knowledge Robyn Laube, Christian Selinger, Rupert W. Leong Therapeutic Advances in Gastroenterology.2022;[Epub] CrossRef
Utility of the MARS-5 in Assessing Medication Adherence in IBD James K Stone, Leigh Anne Shafer, Lesley A Graff, Lisa Lix, Kelcie Witges, Laura E Targownik, Clove Haviva, Kathryn Sexton, Charles N Bernstein Inflammatory Bowel Diseases.2021; 27(3): 317. CrossRef
Non-adherence to Medications in Pregnant Ulcerative Colitis Patients Contributes to Disease Flares and Adverse Pregnancy Outcomes Chikako Watanabe, Masakazu Nagahori, Toshimitsu Fujii, Kaoru Yokoyama, Naoki Yoshimura, Taku Kobayashi, Hirokazu Yamagami, Kazuya Kitamura, Kagaya Takashi, Shiro Nakamura, Makoto Naganuma, Shunji Ishihara, Motohiro Esaki, Maria Yonezawa, Reiko Kunisaki, A Digestive Diseases and Sciences.2021; 66(2): 577. CrossRef
Selected psychological predictors of medication adherence in the older adults with chronic diseases Magdalena Gruszczyńska, Julia Wyszomirska, Anna Daniel‐Sielańczyk, Monika Bąk‐Sosnowska Nursing Open.2021; 8(1): 317. CrossRef
Impacto de la pandemia covid-19 en la adherencia al tratamiento en pacientes con enfermedad inflamatoria intestinal: experiencia de un centro terciario en Chile Rodrigo Quera, Daniela Simian, Lilian Flores, Patricio Ibáñez, Carolina Figueroa Gastroenterología y Hepatología.2021; 44(9): 654. CrossRef
Adherence to Subcutaneous Biological Therapies in Patients with Inflammatory Rheumatic Diseases and Inflammatory Bowel Disease: A Systematic Review Juan C Nieto, Claudia Arajol, Loreto Carmona, Carlos Marras, Luis Cea-Calvo Immunotherapy.2021; 13(5): 433. CrossRef
Researching Interventions to Improve Medication Adherence in Ulcerative Colitis Patients Mila Palma Pacheco, Flora Maria Lorenzo Fortes, Raquel Rocha dos Santos, Genoile Oliveira Santana Silva Journal of Coloproctology.2021; 41(01): 096. CrossRef
Persistence as a Robust Indicator of Medication Adherence-Related Quality and Performance Enrica Menditto, Caitriona Cahir, Sara Malo, Isabel Aguilar-Palacio, Marta Almada, Elisio Costa, Anna Giardini, María Gil Peinado, Mireia Massot Mesquida, Sara Mucherino, Valentina Orlando, Carlos Luis Parra-Calderón, Enrique Pepiol Salom, Przemyslaw Kard International Journal of Environmental Research and Public Health.2021; 18(9): 4872. CrossRef
Effect of point‐of‐care gastrointestinal ultrasound on decision‐making and management in inflammatory bowel disease Antony B. Friedman, Anil Asthana, Simon R. Knowles, Aphra Robbins, Peter R. Gibson Alimentary Pharmacology & Therapeutics.2021; 54(5): 652. CrossRef
Impact of the COVID-19 pandemic on treatment adherence in patients with inflammatory bowel disease: Experience of a tertiary hospital in Chile Rodrigo Quera, Daniela Simian, Lilian Flores, Patricio Ibáñez, Carolina Figueroa Gastroenterología y Hepatología (English Edition).2021; 44(9): 654. CrossRef
Adherence to treatment in patients with inflammatory bowel disease K. A. Andreev, A. V. Gorbenko, Yu. P. Skirdenko, N. A. Nikolaev, M. A. Livzan, G. R. Bikbavova, M. M. Fedorin Bulletin of Siberian Medicine.2021; 20(3): 120. CrossRef
Treatment Adherence in Inflammatory Bowel Disease Patients from Argentina: A Multicenter Study Juan Lasa, Gustavo Correa, Claudia Fuxman, Laura Garbi, Maria Eugenia Linares, Pablo Lubrano, Astrid Rausch, Martin Toro, Martin Yantorno, Ignacio Zubiaurre, Laurent Peyrin-Biroulet, Pablo Olivera Gastroenterology Research and Practice.2020; 2020: 1. CrossRef
Knowledge of disease and self‐management of adolescents with inflammatory bowel diseases Alex Krauthammer, Tal Harel, Noam Zevit, Dror S. Shouval, Raanan Shamir, Batia Weiss Acta Paediatrica.2020; 109(10): 2119. CrossRef
The burden of cost in inflammatory bowel disease: a medical economic perspective Jonathan A. Beard, Benjamin H. Click Current Opinion in Gastroenterology.2020; 36(4): 310. CrossRef
İnflamatuar Bağırsak Hastalıkları Olan Bireylerde İlaç Uyumu ve Yaşam Kalitesi Nazli ÖZTÜRK, Yasemin YILDIRIM Bandırma Onyedi Eylül Üniversitesi Sağlık Bilimleri ve Araştırmaları Dergisi.2020; 2(3): 192. CrossRef
Unmet Medical Needs in the Management of Ulcerative Colitis: Results of an Italian Delphi Consensus Marco Daperno, Alessandro Armuzzi, Silvio Danese, Walter Fries, Giuseppina Liguori, Ambrogio Orlando, Claudio Papi, Mariabeatrice Principi, Fernando Rizzello, Angelo Viscido, Paolo Gionchetti Gastroenterology Research and Practice.2019; 2019: 1. CrossRef
The Development of a Screening Tool to Identify and Classify Nonadherence in Inflammatory Bowel Disease Aria Zand, Audrey Nguyen, Zack Stokes, Welmoed van Deen, Courtney Reynolds, Magdalena Dimitrova, Ariela Khandadash, Miriam Dvorsky, Jenny Sauk, Eric Esrailian, Daniel Hommes Crohn's & Colitis 360.2019;[Epub] CrossRef
Adherence to therapy of patients with inflammatory bowel diseases A I Parfenov, A V Kagramanova, A F Babayan, O V Knyazev Terapevticheskii arkhiv.2018; 90(12): 4. CrossRef