Nearly 70% of adolescents, young adults with UC discontinue 5-ASA treatment in first year
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Key takeaways:
- One-fourth of patients discontinued 5-ASA treatment within the first month and 69% discontinued within 1 year.
- Older individuals and those in less affluent areas were more likely to discontinue treatment.
Adolescents and young adults with ulcerative colitis are at risk for poor adherence to maintenance treatment with 5-aminosalicylic acid in the first year, highlighting the importance of physician follow-up, data showed.
“Long-term 5-aminosalicylic acid (5-ASA) is the first-line treatment for maintaining disease remission in UC,” Nishani Jayasooriya, MBBS, BSc, research fellow and specialist registrar in gastroenterology at St. George’s University Hospitals NHS Foundation Trust, and colleagues wrote in the British Journal of General Practice. “Globally, the incidence of UC is rising fastest in younger populations. ... Therefore, disease control and maintaining remission is paramount for those diagnosed in early life.”
They continued: “Despite this, estimates suggest medication adherence rates in young people are lower than adults with inflammatory bowel disease.”
In a population-based, prospective study, researchers aimed to determine discontinuation and adherence to oral 5-ASA maintenance in the first year of treatment among 607 patients (aged 10-24 years) diagnosed with UC between January 1998 and May 2016. The study population, most of whom were male (56%) and aged 18 to 24 years (70%) at baseline, was identified using the UK Clinical Practice Research Datalink.
Researchers monitored all patients from the treatment start date to 1 year or until de-registration or death.
Results showed 69% of patients discontinued 5-ASA maintenance within 1 year, with one-fourth discontinuing treatment by day 34; the median time to discontinuation was 162 days. Discontinuation rates were lower among adolescents aged 10 to 14 years (61%) and 15 to 17 years (56%) compared with young adults aged 18 to 24 years (74%).
Mean adherence among all patients was 72% (95% CI, 70-75), although researchers reported that adherence dropped from 80% (95% CI, 74-86) among those aged 10 to 14 years at baseline to 78% (95% CI, 72-84) and 69% (95% CI, 66-72) among those aged 15 to 17 years and 18 to 24 years, respectively.
Risk factors for discontinuing therapy included older age (18-24 years) at initiation (adjusted HR = 1.43; 95% CI, 1.04-1.97) and living in less affluent areas (aHR = 1.46; 95% CI, 1.1-1.92). Conversely, experiencing a UC flare that prompted early corticosteroid use led to increased adherence (aHR = 0.68; 95% CI, 0.51-0.9).
“Adolescents and young adults diagnosed with UC starting oral 5-ASA maintenance treatment are at risk of discontinuation and poor adherence, a majority of whom discontinue early in the first year of treatment,” Jayasooria and colleagues concluded. “These findings illustrate the importance of clinicians ensuring careful follow-up within the first year when prescribing lifelong therapies for adolescents and young adults who are diagnosed with UC, particularly adolescents transitioning to young adulthood and those living in deprived areas.”
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