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Treatment nonadherence predicts escalation in children with ulcerative colitis
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Pediatric patients with ulcerative colitis who do not adhere to treatment with mesalamine may experience a decrease in therapeutic efficacy, leading to a need for treatment escalation, according to study results.
Kevin A. Hommel, PhD, of the division of behavioral medicine and clinical psychology at Cincinnati Children’s Hospital, and colleagues wrote that medication nonadherence in children with inflammatory bowel disease has been linked with increased costs and poor outcomes.
“Attention to nonadherence to maintenance medication is critical in pediatric IBD as it may lead to unnecessary treatment escalation, which has implications for both health care utilization and costs,” they wrote. “Additionally, treatment escalation from maintenance therapy to steroids, immunosuppressive medications, biologic agents and surgical interventions involves making often difficult and complex medical decisions and has an impact of health-related quality of life.”
Researchers used pill bottles with electronic caps to objectively measure treatment adherence to determine if adherence was related to remission at week 52 and need for treatment escalation in patients with newly diagnosed UC.
The study comprised 268 patients aged 4 to 17 years with newly diagnosed UC who were followed for 52 weeks. All patients received standardized mesalamine and had established protocols for escalation to thiopurines or anti-TNF.
The primary outcomes of the study were steroid-free remission at week 52 — defined as quiescent disease on mesalamine alone with no corticosteroids for at least 4 weeks prior — and need for treatment escalation — defined as exposure to immunomodulators, calcineurin-inhibitors or anti-TNF.
Although average mesalamine adherence did not predict remission at week 52, Hommel and colleagues found that declining adherence over time strongly predicted treatment escalation (P = .001).
At 6 months of follow-up, rates of adherence to mesalamine of 85.7% or lower were associated with treatment escalation.
“The two adherence trajectories did not diverge until month six, indicating the importance of continued assessment of adherence over at least the first six months following diagnosis in order to identify whether adherence is deteriorating and the likelihood that adherence may be a factor the need for treatment escalation,” Hommel and colleagues wrote. “Targeting adherence difficulties early in the disease course is necessary in reducing the likelihood of the need for treatment escalation in this population.” – by Alex Young
Disclosures : The authors report no relevant financial disclosures.
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