Factors associated with thiopurine non‐adherence in patients with inflammatory bowel disease. Issue 9 (15th September 2013)

• Record Type: Journal Article
• Authors: Goodhand, J. R.; Kamperidis, N.; Sirwan, B.; Macken, L.; Tshuma, N.; Koodun, Y.; Chowdhury, F. A.; Croft, N. M.; Direkze, N.; Langmead, L.; Irving, P. M.; Rampton, D. S.; Lindsay, J. O.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 38:Issue 9(2013)
• Page Start: 1097
• Page End: 1108
• Publication Date: 2013-09-15
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.12476
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt12476-abs-0001"> <title>Summary</title> <sec id="apt12476-sec-0001" sec-type="section"> <title>Background</title> <p>Medication non‐adherence seems to be a particular problem in younger patients with inflammatory bowel disease (IBD) and has a negative impact on disease outcome.</p> </sec> <sec id="apt12476-sec-0002" sec-type="section"> <title>Aims</title> <p>To assess whether non‐adherence, defined using thiopurine metabolite levels, is more common in young adults attending a transition clinic than adults with IBD and whether psychological co‐morbidity is a contributing factor. We also determined the usefulness of the Modified Morisky 8‐item Adherence Scale (MMAS‐8) to detect non‐adherence.</p> </sec> <sec id="apt12476-sec-0003" sec-type="section"> <title>Methods</title> <p>Seventy young adults [51% (36) male] and 74 [62% (46) male] adults were included. Psychological co‐morbidity was assessed using the Hospital Anxiety Depression Scale (HADS) and self‐reported adherence using the MMAS‐8.</p> </sec> <sec id="apt12476-sec-0004" sec-type="section"> <title>Results</title> <p>Twelve percent (18/144) of the patients were non‐adherent. Multivariate analysis [OR, (95% CI), <italic>P</italic> value] confirmed that being young adult [6.1 (1.7–22.5), 0.001], of lower socio‐economic status [1.1 (1.0–1.1), <0.01] and reporting higher HADS‐D scores [1.2 (1.0–1.4), 0.01] were associated with non‐adherence. Receiver operator curve analysis of MMAS‐8 scores gave an area under the curve (95% CI) of 0.85 (0.77–0.92), (<italic>P</italic> < 0.0001): using a cut‐off of <6, the MMAS‐8 score has a sensitivity of 94% and a specificity of 64% to predict thiopurine non‐adherence. Non‐adherence was associated with escalation in therapy, hospital admission and surgeries in the subsequent 6 months of follow up.</p> </sec> <sec id="apt12476-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Non‐adherence to thiopurines is more common in young adults with inflammatory bowel disease, and is associated with lower socio‐economic status and depression. The high negative predictive value of MMAS‐8 scores <6 suggests that it could be a useful screen for thiopurine non‐adherence.</p> </sec> </abstract>