Hu Wen, Hu Shurong, Zhu Yimiao, Chen Hanwen, Chen Yan
Center for Inflammatory Bowel Diseases, Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People's Republic of China.
Patient Prefer Adherence. 2020 Jul 2;14:1083-1092. doi: 10.2147/PPA.S250935. eCollection 2020.
Poor medication adherence in inflammatory bowel disease (IBD) had a negative impact on disease outcomes. In this study, we aimed to determine predictors of low adherence in the Chinese IBD populations and also aimed to compare a self-reported scale to a pharmacy refill index in assessing adherence of 5-ASA and azathioprine taken by Chinese IBD patients.
Adult patients with IBD who had been taking 5-ASA or azathioprine for at least 3 months were recruited from hospital outpatient clinics. The MPR was calculated from previous six-month pharmacy refill data and the self-reported Morisky Medication Adherence Scale (MMAS-8) was issued through QR code questionnaires. Intentional and unintentional adherence scores were calculated according to specific items. Non-adherence was defined as MMAS-8 scores <6 or MPR < 0.8.
The response rate in the IBD patients was as high as 97%. 5-ASA non-adherence rate assessed by MPR was 30% and 37% by MMAS-8, and azathioprine non-adherence rate assessed was 33% by both MPR and MMAS-8. In a linear regression analysis, MPR value was significantly correlated with MMAS-8 score in 5-ASA group (r=0.4, p=0.003), and significantly correlated with unintentional adherence score (r=0.47, p<0.001). No significant correlation was observed between MPR value and MMAS-8 score in azathioprine group. Multivariate analysis demonstrated that age (OR: 1.08; 95% CI: 1.02-1.13; P=0.0015) and previous abdominal surgery (OR: 3.18; 95% CI: 2.09-4.27; P=0.04) were associated with high medication adherence. While patients who had small intestine lesion (OR: 0.09; 95% CI: 0.01-0.17; P=0.006) were associated with low adherence.
Predictors of low adherence were young age, lesions on small intestine, whereas previous abdominal surgery was a protective factor. This study also demonstrated that the MMAS-8 scale was a valid instrument for assessing 5-ASA adherence in IBD patients. Unintentional non-adherence was significantly related to the total non-adherence, which would allow to use the tool to seek ways for adherence improvement.
炎症性肠病（IBD）患者用药依从性差对疾病预后有负面影响。在本研究中，我们旨在确定中国IBD患者群体中依从性低的预测因素，并比较自我报告量表与药房配药指数在评估中国IBD患者服用5-氨基水杨酸（5-ASA）和硫唑嘌呤依从性方面的差异。
从医院门诊招募至少服用5-ASA或硫唑嘌呤3个月的成年IBD患者。根据前六个月的药房配药数据计算药物持有率（MPR），并通过二维码问卷发放自我报告的Morisky药物依从性量表（MMAS-8）。根据特定项目计算有意和无意依从性得分。非依从性定义为MMAS-8得分<6或MPR<0.8。
IBD患者的应答率高达97%。通过MPR评估的5-ASA非依从率为30%，通过MMAS-8评估为37%；通过MPR和MMAS-8评估的硫唑嘌呤非依从率均为33%。线性回归分析显示，5-ASA组中MPR值与MMAS-8得分显著相关（r=0.4，p=0.003），与无意依从性得分显著相关（r=0.47，p<0.001）。硫唑嘌呤组中MPR值与MMAS-8得分之间未观察到显著相关性。多因素分析表明，年龄（比值比：1.08；95%置信区间：1.02-1.13；P=0.0015）和既往腹部手术（比值比：3.18；95%置信区间：2.09-4.27；P=0.04）与高用药依从性相关。而有小肠病变的患者（比值比：0.09；95%置信区间：0.01-0.17；P=0.006）与低依从性相关。
依从性低的预测因素为年轻、小肠病变，而既往腹部手术是一个保护因素。本研究还表明，MMAS-8量表是评估IBD患者5-ASA依从性的有效工具。无意非依从性与总体非依从性显著相关，这有助于利用该工具寻找提高依从性的方法。
