Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2016 May;10(5):549-55.
doi: 10.1093/ecco-jcc/jjw002. Epub 2016 Jan 6.

Non-adherence to Anti-TNF Therapy is Associated with Illness Perceptions and Clinical Outcomes in Outpatients with Inflammatory Bowel Disease: Results from a Prospective Multicentre Study

Mike van der Have  1 , Bas Oldenburg  2 , Ad A Kaptein  3 , Jeroen M Jansen  4 , Robert C H Scheffer  5 , Bas A van Tuyl  6 , Andrea E van der Meulen-de Jong  7 , Marieke Pierik  8 , Peter D Siersema  2 , Martijn G H van Oijen  9 , Herma H Fidder  2
Affiliations
Observational Study

Non-adherence to Anti-TNF Therapy is Associated with Illness Perceptions and Clinical Outcomes in Outpatients with Inflammatory Bowel Disease: Results from a Prospective Multicentre Study

Mike van der Have et al. J Crohns Colitis. 2016 May.

Erratum in

Abstract

Background and aims: Non-adherence to anti-tumour necrosis factor [TNF] agents in patients with inflammatory bowel disease [IBD] is a serious problem. In this study, we assessed risk factors for non-adherence and examined the association between adherence to anti-TNF agents and loss of response [LOR].

Methods: In this multicentre, 12-month observational study, outpatients with IBD were included. Demographic and clinical characteristics were recorded. Adherence was measured with the Modified Morisky Adherence Scale-8 [MMAS-8] and 12-month pharmacy refills [medication possession ratio, MPR]. Risk factors included demographic and clinical characteristics, medication beliefs, and illness perceptions. Cox regression analysis was performed to determine the association between MPR and LOR to anti-TNF, IBD-related surgery or hospitalisation, dose intensification, or discontinuation of anti-TNF.

Results: In total, 128 patients were included [67 infliximab, 61 adalimumab], mean age 37 ( ± standard deviation [SD] 14) years, 71 [56%] female. Median disease duration was 8 (interquartile range [IQR] 4-14) years. Clinical disease activity was present in 41/128 [32%] patients, 36/127 [28%] patients had an MMAS-8 < 6 ['low adherence'], and 25/99 [25%] patients had an MPR < 80% [non-adherence]. Risk factors for non-adherence included adalimumab use (odds ratio [OR] 10.1, 95% confidence interval [CI] 2.62-40.00), stronger emotional response [OR 1.16, 95% CI 1.02-1.31], and shorter timeline perception, i.e. short perceived illness duration [OR 0.60, 95% CI 0.38-0.96]. Adherence is linearly and negatively [OR 0.14, 95% CI 0.03-0.63] associated with LOR.

Conclusion: Non-adherence to anti-TNF agents is strongly associated with LOR to anti-TNF agents, adalimumab use, and illness perceptions. The latter may provide an important target for interventions aimed at improving adherence and health outcomes.

Keywords: Inflammatory bowel disease; adherence; illness perceptions; medication beliefs; predictors.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flow-chart. [a] Modified Morisky Adherence Scale, 8 items; [b] follow-up.
Figure 2.
Figure 2.
Independent risk factors of low adherence (Modified Morisky Adherence Scale [MMAS]-8 score < 6].
Figure 3.
Figure 3.
Independent risk factors of non-adherence (medication possession ratio [MPR] < 80%).
Figure 4.
Figure 4.
Association between medication possession ratio [MPR] category and proportion of patients with loss of response [%].
See this image and copyright information in PMC

References

    1. Ford AC, Sandborn WJ, Khan KJ, Hanauer SB, Talley NJ, Moayyedi P. Efficacy of biological therapies in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol 2011;106:644–59. - PubMed
    1. Costa J, Magro F, Caldeira D, Alarcão J, Sousa R, Vaz-Carneiro A. Infliximab reduces hospitalisations and surgery interventions in patients with inflammatory bowel disease: a systematic review and meta-analysis. Inflamm Bowel Dis 2013;19:2098–110. - PubMed
    1. Feagan BG, Panaccione R, Sandborn WJ, et al. Effects of adalimumab therapy on incidence of hospitalisation and surgery in Crohn’s disease: results from the CHARM study. Gastroenterology 2008;135:1493–9. - PubMed
    1. Sandborn WJ, Rutgeerts P, Feagan BG, et al. Colectomy rate comparison after treatment of ulcerative colitis with placebo or infliximab. Gastroenterology 2009;137:1250–60. - PubMed
    1. Fidder HH, Singendonk MM, van der Have M, Oldenburg B, van Oijen MG. Low rates of adherence for tumor necrosis factor-α inhibitors in Crohn’s disease and rheumatoid arthritis: results of a systematic review. World J Gastroenterol 2013;19:4344–50. - PMC - PubMed

Publication types

LinkOut - more resources