Melesse Dessalegn Y, Targownik Laura E, Singh Harminder, Blanchard James F, Bernstein Charles N
*Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada; and †Section of Gastroenterology, Department of Internal Medicine, IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada.
Inflamm Bowel Dis. 2015 Jul;21(7):1615-22. doi: 10.1097/MIB.0000000000000418.
To evaluate patterns and predictors of long-term nonuse of inflammatory bowel disease (IBD)-specific medications among patients with IBD.
All incident cases of IBD diagnosed between 1987 and 2012 were identified from the population-based University of Manitoba IBD Epidemiology Database. Point prevalence of long-term medication nonuse (defined as no receipt of IBD-specific medications for a year or longer) was determined over calendar time and the course of disease. Cox proportional hazard regression analysis was performed to identify factors associated with delayed initiation and with becoming a long-term nonuser.
Among 6451 persons with IBD followed since 1987 (46.8% male, 47.8% with Crohn's disease), 11.7% were not dispensed an IBD-specific medication within the first year and 6.2% within 5 years after diagnosis. Factors associated with delayed initiation included having Crohn's disease (hazard ratio [HR] = 0.78, 95% confidence interval [CI], 0.73-0.83), lower socioeconomic status (HR = 0.91, 95% CI, 0.84-0.98), age more than 65 years (HR = 0.76, 95% CI, 0.67-0.86), and having any medical comorbidity. The prevalence of long-term nonuse consistently remained between 40% and 50% of persons with IBD across the study years. Patients with Crohn's disease (HR = 1.14, 95% CI, 1.04-1.25), lower socioeconomic status (HR = 1.14, 95% CI, 1.02-1.27), patients with IBD-associated surgery (HR = 1.72, 95% CI, 1.51-1.96), or delayed initiation of first IBD medication were more likely to become long-term nonusers after initiation.
At any given time, roughly half of all patients with IBD have not used IBD-specific medications in the previous year. Further work is required to evaluate the clinical implications of long-term medication nonuse in IBD.
评估炎症性肠病（IBD）患者长期不使用IBD特异性药物的模式及预测因素。
从基于人群的曼尼托巴大学IBD流行病学数据库中识别出1987年至2012年期间确诊的所有IBD新发病例。在日历时间和疾病进程中确定长期不使用药物（定义为一年或更长时间未接受IBD特异性药物治疗）的时点患病率。进行Cox比例风险回归分析，以确定与延迟用药起始及成为长期未使用者相关的因素。
自1987年起随访的6451例IBD患者中（46.8%为男性，47.8%为克罗恩病患者），11.7%在诊断后的第一年内未接受IBD特异性药物治疗，5年内未接受治疗的比例为6.2%。与延迟用药起始相关的因素包括患有克罗恩病（风险比[HR]=0.78，95%置信区间[CI]，0.73 - 0.83）、社会经济地位较低（HR = 0.91，95% CI，0.84 - 0.98）、年龄超过65岁（HR = 0.76，95% CI，0.67 - 0.86）以及患有任何合并症。在整个研究年份中，IBD患者长期不使用药物的患病率始终保持在40%至50%之间。患有克罗恩病的患者（HR = 1.14，95% CI，1.04 - 1.25）、社会经济地位较低的患者（HR = 1.14，95% CI，1.02 - 1.27）、接受过IBD相关手术的患者（HR = 1.72，95% CI，1.51 - 1.96）或首次IBD药物治疗起始延迟的患者在开始用药后更有可能成为长期未使用者。
在任何给定时间，大约一半的IBD患者在前一年未使用IBD特异性药物。需要进一步开展工作以评估IBD患者长期不使用药物的临床意义。
