Shinzaki Shinichiro, Sakagami Kayoko, Matsumoto Miki, Takehara Tetsuo, Ito Hiroaki
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.
Kinshukai Infusion Clinic, Osaka, Japan.
Crohns Colitis 360. 2021 Dec 16;4(1):otab081. doi: 10.1093/crocol/otab081. eCollection 2022 Jan.
Drug adherence is critically important for patients on thiopurines. We examined whether nurse-provided medication guidance improves drug adherence to thiopurines and clinical activity in patients with inflammatory bowel disease (IBD).
IBD outpatients taking a stable dose of thiopurines for 1 year were enrolled. After a baseline survey including the Morisky Medication Adherence Scale (MMAS)-8, nurses provided medication guidance to each patient using a specialized leaflet. The same survey was conducted 2 and 6 months after the guidance.
Among 110 enrolled patients, 74 met the analysis criteria. In the low adherence group (MMAS-8 <6), the median MMAS-8 score significantly increased from 4 (range 1-5.75) to 5.25 (2-7) at 2 months ( = .0135) to 5.625 (2.5-7.75) at 6 months ( = .0004), but not in overall or the high adherence group (MMAS-8 ≥6). Older age (≥43 years, odds ratio [OR] = 5.63, 95% confidence interval [CI]: 1.59-19.9, = .0074) and shorter disease duration (<129 months, OR = 6.78, 95% CI: 1.77-26.0, = .0052) were independently associated with high adherence. Although clinical activity scores did not change during the observation period, the overall mean corpuscular volume (MCV) level significantly increased from 92.3 fL (61.4-105.5) to 92.5 (73.7-107.8) at 2 months ( = .0288) and 93.9 (74.4-107.6) at 6 months ( = .0062). MCV levels significantly increased in the low adherence group at 6 months (92.2 [72.2-105.5] to 94.0 [74.4-107.6], = .0392) and tended to increase in the high adherence group (92.3 [61.4-101.2] to 93.6 [74.9-99.7], = .0651).
Nurse-provided medication guidance improved drug adherence to thiopurines in IBD patients with low adherence and can also benefit those with high adherence.
药物依从性对于服用硫唑嘌呤的患者至关重要。我们研究了护士提供的用药指导是否能提高炎症性肠病（IBD）患者对硫唑嘌呤的药物依从性及临床活性。
纳入服用稳定剂量硫唑嘌呤1年的IBD门诊患者。在包括Morisky药物依从性量表（MMAS）-8的基线调查后，护士使用专门的宣传册为每位患者提供用药指导。在指导后2个月和6个月进行相同的调查。
在110名纳入患者中，74名符合分析标准。在低依从性组（MMAS-8<6）中，MMAS-8评分中位数在2个月时从4（范围1-5.75）显著增加至5.25（2-7）（P = .0135），在6个月时增加至5.625（2.5-7.75）（P = .0004），但在总体或高依从性组（MMAS-8≥6）中未增加。年龄较大（≥43岁，比值比[OR]=5.63，95%置信区间[CI]：1.59-19.9，P = .0074）和病程较短（<129个月，OR = 6.78，95%CI：1.77-26.0，P = .0052）与高依从性独立相关。尽管观察期内临床活性评分未改变，但总体平均红细胞体积（MCV）水平在2个月时从92.3 fL（61.4-105.5）显著增加至92.5（73.7-107.8）（P = .0288），在6个月时增加至93.9（74.4-107.6）（P = .0062）。低依从性组的MCV水平在6个月时显著增加（从92.2[72.2-105.5]至94.0[74.4-107.6]，P = .0392），高依从性组有增加趋势（从92.3[61.4-101.2]至93.6[74.9-99.7]，P = .0651）。
护士提供的用药指导提高了低依从性IBD患者对硫唑嘌呤的药物依从性，对高依从性患者也有益处。
