Broekman Mark M T J, Coenen Marieke J H, Wanten Geert J, van Marrewijk Corine J, Kievit Wietske, Klungel Olaf H, Verbeek André L M, Wong Dennis R, Hooymans Piet M, Guchelaar Henk-Jan, Scheffer Hans, Derijks Luc J J, Bouvy Marcel L, de Jong Dirk J
Department of Gastroenterology, Radboud Institute for Molecular Life Sciences.
Departments of Human Genetics.
Eur J Gastroenterol Hepatol. 2018 Feb;30(2):167-173. doi: 10.1097/MEG.0000000000001025.
Patients' beliefs about medicine may either reflect the necessity for treatment or concerns regarding the treatment. We explored the extent to which these beliefs have an effect on thiopurine metabolite levels and premature discontinuation in patients with inflammatory bowel disease (IBD).
Patients enrolled in the 'Thiopurine response Optimization by Pharmacogenetic testing in Inflammatory Bowel Disease Clinics' (TOPIC) trial were asked to complete the Beliefs about Medicine Questionnaire (BMQ) 4 weeks after thiopurine initiation. The BMQ measures perceptions about treatment necessity and concerns. On the basis of the necessity and concern scores, patients can be categorized as accepting, ambivalent, indifferent, or skeptical. The thiopurine discontinuation rates for these belief subgroups were compared by Kaplan-Meier curves. Furthermore, clinical response and metabolite levels were compared between the belief subgroups.
A total of 767 patients with IBD started thiopurine treatment, of whom 576 (75%) completed the BMQ. Patients could be classified as accepting (34%), indifferent (17%), ambivalent (34%), or skeptical (15%). Compared with patients in the accepting group (discontinuation rate 22%), patients with an indifferent (35%; P=0.02), ambivalent (37%; P<0.01), or skeptical belief (54%; P<0.01) had higher thiopurine discontinuation rates. No differences were observed in the steady-state thiopurine metabolite levels between the different belief subgroups.
Patients with a low perceived treatment necessity or high concerns toward IBD treatment were more likely to discontinue thiopurine treatment prematurely. Extra attention toward these patients might prevent premature discontinuation.
患者对药物的信念可能反映出治疗的必要性或对治疗的担忧。我们探讨了这些信念在多大程度上影响炎症性肠病（IBD）患者的硫嘌呤代谢物水平和过早停药情况。
参加“炎症性肠病诊所通过药物遗传学检测优化硫嘌呤反应”（TOPIC）试验的患者在开始使用硫嘌呤4周后被要求完成药物信念问卷（BMQ）。BMQ衡量对治疗必要性的认知和担忧。根据必要性和担忧得分，患者可分为接受型、矛盾型、冷漠型或怀疑型。通过Kaplan-Meier曲线比较这些信念亚组的硫嘌呤停药率。此外，还比较了信念亚组之间的临床反应和代谢物水平。
共有767例IBD患者开始硫嘌呤治疗，其中576例（75%）完成了BMQ。患者可分为接受型（34%）、冷漠型（17%）、矛盾型（34%）或怀疑型（15%）。与接受组患者（停药率22%）相比，冷漠型（35%；P=0.02）、矛盾型（37%；P<0.01）或怀疑型信念患者（54%；P<0.01）的硫嘌呤停药率更高。不同信念亚组之间的硫嘌呤稳态代谢物水平未观察到差异。
对IBD治疗必要性认知较低或担忧较高的患者更有可能过早停用硫嘌呤治疗。对这些患者给予额外关注可能会防止过早停药。
