TY - JOUR
T1 - Clinical Predictors of Future Nonadherence in Inflammatory Bowel Disease
AU - Severs, Mirjam
AU - Mangen, Marie Josée J.
AU - Fidder, Herma H.
AU - Van Der Valk, Mirthe E.
AU - Van Der Have, Mike
AU - Van Bodegraven, Ad A.
AU - Clemens, Cees H M
AU - Dijkstra, Gerard
AU - Jansen, Jeroen M.
AU - de Jong, Dirk J
AU - Mahmmod, Nofel
AU - van de Meeberg, Paul C
AU - Van der Meulen-de Jong, Andrea E
AU - Pierik, Marieke
AU - Ponsioen, Cyriel Y
AU - Romberg-Camps, Marielle J.L.
AU - Siersema, Peter D.
AU - Jharap, Bindia
AU - van der Woude, C Janneke
AU - Zuithoff, Nicolaas P.A.
AU - Oldenburg, Bas
N1 - Funding Information:
H. H. Fidder has acted as a consultant for AbbVie. G. Dijkstra participated on an advisory board of Mundipharma. A. A. van Bodegraven has acted as a consultant for AbbVie, Ferring, MSD-Merck, and Tramedico, and received payments for lectures from AbbVie, Ferring, Pfizer and Takeda. D. J. de Jong has acted as a consultant for Synthon Netherlands and received payments for lectures from AbbVie, Ferring, and MSD. J. C. van der Woude has acted as a consultant for AbbVie, Ferring, Shire, and MSD and received payment for lectures from AbbVie, Falk Pharma, and MSD. J. M. Jansen has acted as a consultant for AbbVie, MSD, Ferring, and Falk and received payments for lectures for AbbVie and MSD. P. C. van de Meeberg received payments for lectures for Falk. C. Y. Ponsioen has acted as a consultant for AbbVie and received payments for lectures from Ferring and MSD. A. E. van der Meulen-de Jong has acted as consultant for AbbVie, MSD, Ferring, and Falk and received payments for lectures from AbbVie and MSD. B. Oldenburg has acted as a consultant for AbbVie, Takeda, and MSD and received payment for lectures from Ferring, MSD, and AbbVie. The remaining authors have no conflict of interest to disclose.
Funding Information:
Received for publication December 23, 2016; Accepted April 18, 2017. From the 1Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands; 2Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; 3Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; 4Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands; 5Department of Gastroenterology and Hepatology (Co-MIK), Zuyderland Medical Center, Heerlen, Sittard, Geleen, the Netherlands; 6Department of Gastroenterology and Hepatology, Diaconessenhuis, Leiden, the Netherlands; 7Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands; 8Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands; 9Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands; 10Department of Gastroenterology and Hepatology, Antonius Hospital, Nieuwegein, the Netherlands; 11Department of Gastroenterology and Hepatology, Slingeland Hospital, Doetinchem, the Netherlands; 12Department of Gastroenterology and Hepatology, Leiden University Medical Center, the Netherlands; 13Department of Gastroenterology and Hepatology, Maastricht University Medical Center, the Netherlands; 14Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands; 15Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, the Netherlands; and 16Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands. The COIN-study was supported by an unrestricted grant from AbbVie. Author disclosures are available in the Acknowledgments. Address correspondence to: Bas Oldenburg, MD, PhD, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands (e-mail: [email protected]). Copyright © 2017 Crohn ’s & Colitis Foundation DOI 10.1097/MIB.0000000000001201 Published online 11 July 2017.
Publisher Copyright:
© 2017 Crohn's & Colitis Foundation.
PY - 2017/9
Y1 - 2017/9
N2 - BACKGROUND: Nonadherence to medical therapy is frequently encountered in patients with inflammatory bowel disease (IBD). We aimed to identify predictors for future (non)adherence in IBD.METHODS: We conducted a multicenter prospective cohort study with adult patients with Crohn's disease (CD) and ulcerative colitis (UC). Data were collected by means of 3-monthly questionnaires on the course of disease and healthcare utilization. Medication adherence was assessed using a visual analogue scale, ranging from 0% to 100%. Levels <80% were considered to indicate nonadherence. The Brief Illness Perception Questionnaire was used to identify illness perceptions. We used a logistic regression analysis to identify patient- and disease-related factors predictive of nonadherence 3 months after the assessment of predictors.RESULTS: In total, 1558 patients with CD and 1054 patients with UC were included and followed for 2.5 years. On average, 12.1% of patients with CD and 13.3% of patients with UC using IBD-specific medication were nonadherent. Nonadherence was most frequently observed in patients using mesalazine (CD), budesonide (UC) and rectally administrated therapy (both CD and UC). A higher perceived treatment control and understanding of the disease were associated with adherence to medical therapy. Independent predictors of future nonadherence were age at diagnosis (odds ratio [OR]: 0.99 per year), nonadherence (OR: 26.91), a current flare (OR: 1.30) and feelings of anxiety/depression (OR: 1.17), together with an area under the receiver-operating-characteristics curve of 0.74.CONCLUSIONS: Lower age at diagnosis, flares, feelings of anxiety or depression, and nonadherence are associated with future nonadherence in patients with IBD. Altering illness perceptions could be an approach to improve adherence behavior.
AB - BACKGROUND: Nonadherence to medical therapy is frequently encountered in patients with inflammatory bowel disease (IBD). We aimed to identify predictors for future (non)adherence in IBD.METHODS: We conducted a multicenter prospective cohort study with adult patients with Crohn's disease (CD) and ulcerative colitis (UC). Data were collected by means of 3-monthly questionnaires on the course of disease and healthcare utilization. Medication adherence was assessed using a visual analogue scale, ranging from 0% to 100%. Levels <80% were considered to indicate nonadherence. The Brief Illness Perception Questionnaire was used to identify illness perceptions. We used a logistic regression analysis to identify patient- and disease-related factors predictive of nonadherence 3 months after the assessment of predictors.RESULTS: In total, 1558 patients with CD and 1054 patients with UC were included and followed for 2.5 years. On average, 12.1% of patients with CD and 13.3% of patients with UC using IBD-specific medication were nonadherent. Nonadherence was most frequently observed in patients using mesalazine (CD), budesonide (UC) and rectally administrated therapy (both CD and UC). A higher perceived treatment control and understanding of the disease were associated with adherence to medical therapy. Independent predictors of future nonadherence were age at diagnosis (odds ratio [OR]: 0.99 per year), nonadherence (OR: 26.91), a current flare (OR: 1.30) and feelings of anxiety/depression (OR: 1.17), together with an area under the receiver-operating-characteristics curve of 0.74.CONCLUSIONS: Lower age at diagnosis, flares, feelings of anxiety or depression, and nonadherence are associated with future nonadherence in patients with IBD. Altering illness perceptions could be an approach to improve adherence behavior.
KW - Adult
KW - Age of Onset
KW - Anxiety/psychology
KW - Area Under Curve
KW - Colitis, Ulcerative/drug therapy
KW - Crohn Disease/drug therapy
KW - Depression/psychology
KW - Female
KW - Gastrointestinal Agents/therapeutic use
KW - Health Surveys
KW - Humans
KW - Male
KW - Medication Adherence/psychology
KW - Middle Aged
KW - Odds Ratio
KW - Prospective Studies
KW - ROC Curve
KW - Risk Factors
KW - Severity of Illness Index
KW - Symptom Flare Up
KW - Crohn's disease
KW - medication adherence
KW - prediction
KW - ulcerative colitis
UR - http://www.scopus.com/inward/record.url?scp=85028320290&partnerID=8YFLogxK
U2 - 10.1097/MIB.0000000000001201
DO - 10.1097/MIB.0000000000001201
M3 - Article
C2 - 28700534
AN - SCOPUS:85028320290
SN - 1078-0998
VL - 23
SP - 1568
EP - 1576
JO - Inflammatory bowel diseases
JF - Inflammatory bowel diseases
IS - 9
ER -