Ulcerative colitis can be maintained in remission with 5-aminosalicylic acid medications.
However, frequent non-adherence by patients who are feeling well has been associated with more frequent flares of colitis.
Dr Higgins and colleagues from Michigan, USA performed a systematic review of the published literature and unpublished randomized clinical trials.
The trials assessed the impact of non-adherence with 5-aminosalicylic acid medications on the incidence of ulcerative colitis flares and costs of care.
The team performed a search of MEDLINE, EMBASE and the Cochrane databases.
|The relative risk for flare in non-adherent vs adherent patients was 3.7|
|Alimentary Pharmacology & Therapeutics |
Prospective studies of ulcerative colitis maintenance with 5-aminosalicylic acids in adults were selected if they included data on adherence and disease flares.
Studies using insurance claims data to estimate the impact of non-adherence on cost of care were included.
The research team obtained data from unpublished randomized clinical trials from the FDA with a request under the Freedom of Information Act.
The researchers found that the relative risk for flare in non-adherent vs adherent patients ranged from 3.7 to infinity.
Data were obtained from 6 unpublished 5-aminosalicylic acid randomized clinical trials, but none measured the impact of adherence on disease activity.
The team noted that the comorbidity-adjusted annual costs of care in adherent patients were 13% less than in non-adherent patients, despite increased medication expenditures.
Dr Higgins’ team concluded, “A substantial proportion of ulcerative colitis flares and medical costs of ulcerative colitis are attributable to 5-aminosalicylic acid non-adherence.”
“As non-adherence to 5-aminosalicylic acid medications is common, cost-effective strategies to improve adherence are needed.”
“The impact of adherence on disease activity should be measured in randomized clinical trials of all inflammatory bowel disease treatments.”