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Factors associated with thiopurine non-adherence in IBD

The latest issue of the Alimentary Pharmacology & Therapeutics identifies factors associated with thiopurine non-adherence in patients with inflammatory bowel disease.

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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.

Dr Lindsay and colleagues from the United Kingdom assessed 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.

The research team also determined the usefulness of the Modified Morisky 8-item Adherence Scale (MMAS-8) to detect non-adherence.

The team evaluated 70 young adults.

12% of the patients were non-adherent
Alimentary Pharmacology & Therapeutics

Psychological co-morbidity was assessed using the Hospital Anxiety Depression Scale (HADS) and self-reported adherence using the MMAS-8.

The researchers found that 12% of the patients were non-adherent.

Multivariate analysis confirmed that being young adult, of lower socio-economic status, and reporting higher HADS-D scores were associated with non-adherence.

Receiver operator curve analysis of MMAS-8 scores gave an area under the curve of 0.85, using a cut-off of less than 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.

Dr Lindsay's team concludes, "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."

Aliment Pharmacol Ther 2013: 38(9): 1097–1108
22 October 2013

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