Bhasin Sanchit, Singh Harminder, Targownik Laura E, Israeli Eran, Bernstein Charles N
*Department of Internal Medicine, Section of Gastroenterology, IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada; and †IBD Unit, Department of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Hospital, Jerusalem, Israel.
Inflamm Bowel Dis. 2016 Apr;22(4):919-24. doi: 10.1097/MIB.0000000000000753.
We aimed to determine the rates and reasons for nonuse of inflammatory bowel disease (IBD)-specific medication in a referral clinic.
Consecutive persons with Crohn's disease (CD) (n = 423) and ulcerative colitis (UC) (n = 342) were followed in a single clinic over 2 years. At each patient visit, it was determined whether and what type of IBD-specific medications were used at that visit. If medications were not used, the reason for nonuse was recorded. Disease remission, further stratified by "clinical remission" and "deep remission" (clinical remission plus imaging evidence of remission), was considered a reason for nonuse if the attending physician believed the person was in remission and agreed for them to be off medications.
Nonuse of IBD-specific medication was seen in 121 persons with CD (29%) and 65 persons with UC (18%). In CD, increased age and disease duration were associated with nonuse; disease phenotype did not predict nonuse. In UC, disease duration was associated with nonuse but age was not. In CD, the most common reason for medication nonuse was deep remission (22.5%), followed by clinical remission (21.4%), not having seen a gastroenterologist for a lengthy period (21.4%) and nonadherence (16%). In UC, nonuse was attributed to deep remission (27.7%), followed by nonadherence (26.3%) and clinical remission (23%).
Approximately a quarter of persons with IBD attending at a tertiary care practice do not use IBD-specific medications with a higher rate in CD than UC. The decision not to use medications was deemed appropriate in approximately one-half of all nonusers.
我们旨在确定转诊诊所中未使用炎症性肠病（IBD）特异性药物的比例及原因。
在一家诊所对423例克罗恩病（CD）患者和342例溃疡性结肠炎（UC）患者进行了为期2年的连续随访。每次患者就诊时，确定该次就诊是否使用以及使用何种IBD特异性药物。如果未使用药物，则记录未使用的原因。如果主治医师认为患者处于缓解期并同意其停用药物，疾病缓解（进一步分为“临床缓解”和“深度缓解”，即临床缓解加缓解的影像学证据）被视为未使用药物的一个原因。
121例CD患者（29%）和65例UC患者（18%）未使用IBD特异性药物。在CD中，年龄增加和病程延长与未使用药物有关；疾病表型不能预测未使用情况。在UC中，病程与未使用药物有关，但年龄无关。在CD中，未使用药物最常见的原因是深度缓解（22.5%），其次是临床缓解（21.4%）、长时间未看胃肠病医生（21.4%）和不依从（16%）。在UC中，未使用药物归因于深度缓解（27.7%），其次是不依从（26.3%）和临床缓解（23%）。
在三级医疗实践中就诊的IBD患者中，约四分之一未使用IBD特异性药物，CD患者的未使用比例高于UC患者。在所有未使用者中，约一半不使用药物的决定被认为是合适的。
