van der Have Mike, Oldenburg Bas, Kaptein Ad A, Jansen Jeroen M, Scheffer Robert C H, van Tuyl Bas A, van der Meulen-de Jong Andrea E, Pierik Marieke, Siersema Peter D, van Oijen Martijn G H, Fidder Herma H
Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
J Crohns Colitis. 2016 May;10(5):549-55. doi: 10.1093/ecco-jcc/jjw002. Epub 2016 Jan 6.
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].
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.
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.
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.
炎症性肠病（IBD）患者对抗肿瘤坏死因子（TNF）药物治疗的不依从是一个严重问题。在本研究中，我们评估了不依从的风险因素，并研究了TNF药物依从性与反应丧失（LOR）之间的关联。
在这项为期12个月的多中心观察性研究中，纳入了IBD门诊患者。记录了人口统计学和临床特征。使用改良的Morisky药物依从性量表8（MMAS-8）和12个月的药房配药情况（药物持有率，MPR）来衡量依从性。风险因素包括人口统计学和临床特征、用药信念和疾病认知。进行Cox回归分析以确定MPR与抗TNF药物的LOR、IBD相关手术或住院、剂量增加或抗TNF药物停用之间的关联。
总共纳入了128例患者（英夫利昔单抗67例，阿达木单抗61例），平均年龄37（±标准差[SD]14）岁，女性71例（56%）。疾病中位病程为8（四分位间距[IQR]4-14）年。41/128例（32%）患者存在临床疾病活动，36/127例（28%）患者的MMAS-8评分<6（“低依从性”），25/99例（25%）患者的MPR<80%（不依从）。不依从的风险因素包括使用阿达木单抗（比值比[OR]10.1，95%置信区间[CI]2.62-40.00）、更强烈的情绪反应[OR 1.16，95%CI 1.02-1.31]以及较短的时间感知，即较短的疾病感知持续时间[OR 0.60，95%CI 0.38-0.96]。依从性与LOR呈线性负相关[OR 0.14，95%CI 0.03-0.63]。
抗TNF药物的不依从与抗TNF药物的LOR、阿达木单抗的使用以及疾病认知密切相关。后者可能为旨在提高依从性和改善健康结局的干预措施提供重要靶点。
