Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, United Kingdom.
Inflamm Bowel Dis. 2019 Apr 11;25(5):919-924. doi: 10.1093/ibd/izy309.
Adherence to maintenance medication for inflammatory bowel disease (IBD) is essential for disease control, albeit often poor. Adherence can be measured by drug metabolites, self-report tools, and prescription data. The aim of this study was to test implementation of self-report tools in IBD clinics by evaluating consistency and to validate them by correlation with drug metabolite levels and medication possession ratios (MPRs).
Ambulatory IBD patients on thiopurine maintenance therapy for >3 months were recruited. Patients self-reported adherence using a visual analog scale (VAS) and Medication Adherence Report Scale (MARS). Thiopurine metabolites levels were assessed using blood, and MPRs were calculated from patient records as the reference standard. Consistency was assessed by McNemar's test (primary outcome), and correlation analysis was performed using Pearson tests.
Of 96 patients (58 Crohn's disease, 33 ulcerative colitis, 5 IBD unclassified) 16.6% were classified as nonadherent based on thiopurine metabolites, 14.9% based on VAS, 13.2% based on MARS, and 22.9% based on MPR. VAS and MARS were consistent with thiopurine metabolites (McNemar test P = 0.79, P = 0.45). All 4 methods were consistent with each other when compared directly 1 to 1. Spearman's analysis demonstrated that all 4 methods significantly correlated with each other: (correlation between VAS and thiopurine metabolites: rho = 0.435; P < 0.001; and correlation between MARS and thiopurine metabolites: rho = 0.29; P = 0.005).
Self-report tools correlate significantly with thiopurine metabolites and medication possession ratios. The Medication Adherence Report Scale and VAS are validated adherence assessment tools for IBD and can be used as simple screening tools in clinical practice.
炎症性肠病（IBD）患者维持药物治疗的依从性对于疾病控制至关重要，但往往较差。药物依从性可以通过药物代谢物、自我报告工具和处方数据来衡量。本研究旨在通过评估一致性来检验 IBD 诊所中自我报告工具的实施情况，并通过与药物代谢物水平和药物持有率（MPR）的相关性来验证其有效性。
招募了正在接受硫嘌呤维持治疗>3 个月的门诊 IBD 患者。患者使用视觉模拟量表（VAS）和药物依从性报告量表（MARS）自我报告药物依从性。使用血液评估硫嘌呤代谢物水平，并从患者记录中计算 MPR 作为参考标准。使用 McNemar 检验评估一致性（主要结局），并使用 Pearson 检验进行相关性分析。
在 96 名患者（58 名克罗恩病、33 名溃疡性结肠炎、5 名 IBD 未分类）中，根据硫嘌呤代谢物、VAS、MARS 和 MPR，分别有 16.6%、14.9%、13.2%和 22.9%的患者被归类为不依从。VAS 和 MARS 与硫嘌呤代谢物一致（McNemar 检验 P=0.79，P=0.45）。当直接比较 1 对 1 时，所有 4 种方法都相互一致。Spearman 分析表明，所有 4 种方法彼此之间均有显著相关性：（VAS 与硫嘌呤代谢物之间的相关性：rho=0.435；P<0.001；MARS 与硫嘌呤代谢物之间的相关性：rho=0.29；P=0.005）。
自我报告工具与硫嘌呤代谢物和药物持有率显著相关。药物依从性报告量表和 VAS 是 IBD 患者药物依从性评估的有效工具，可以作为临床实践中的简单筛选工具。
