Pagnini Cristiano, Antonelli Elisabetta, Scrivo Barbara, Cappello Maria, Soncini Marco, Vassallo Roberto, Mocci Giammarco, Di Paolo Maria Carla
Azienda Ospedaliera S. Giovanni Addolorata, 00184 Roma, Italy.
Ospedale Santa Maria della Misericordia, 06129 Perugia, Italy.
J Pers Med. 2025 Mar 24;15(4):123. doi: 10.3390/jpm15040123.
: Ulcerative colitis (UC) is a part of inflammatory bowel disease (IBD) and it is characterized by colonic-mucosal chronic inflammation with intermittent clinical activity. Personalized medicine is becoming more and more a relevant method of approach in this field, and the identification of potential concerns in a single patient may contribute to the improvement of the clinical approach. Mesalamine represents the cornerstone of therapy for mild-moderate disease forms, but non-adherence to medical therapy represents a critical health problem, although it is underestimated by many physicians, with evident consequences in terms of disease-related complications. The aim of the present study is to evaluate the magnitude of non-adherence to oral mesalamine in UC patients performing a systematic review and meta-analysis of literature. : A literature search in PubMed and Cochrane databases was performed for studies reporting the non-adherence rate to oral mesalamine in adult UC patients, and eligible studies have been selected for evaluation. The type of study (trial vs. observational), geographic area, sample size, method of adherence assessment, and non-adherence rate were considered. : From a total of 464 articles, 34 studies were included in the meta-analysis after selection. Sixteen studies (47%) are observational, and eighteen (53%) are clinical trials. A total of 12/34 (35%) studies are from North America, 14/34 (41%) from Europe, 4/34 (12%) from Asia, with 4/34 (12%) from mixed areas of the world. The mean non-adherence rate was 32%, but with a consistent variability among the studies. In particular, the non-adherence rate was significantly higher in observational studies vs. clinical trials (47 vs. 20%, < 0.001), and in North American vs. European and Asian studies (54 vs. 23 vs. 4%, respectively, < 0.001). : The non-adherence rate to oral mesalamine is variably reported in the literature due to the inhomogeneity of available studies, but it represents a consistent problem, often neglected, that deserves future research. A personalized approach by a physician to a single patient can improve the effectiveness of medical therapy and the management of UC patients.
溃疡性结肠炎（UC）是炎症性肠病（IBD）的一部分，其特征为结肠黏膜慢性炎症伴间歇性临床活动。在该领域，个性化医疗正日益成为一种重要的治疗方法，识别单个患者的潜在问题可能有助于改进临床治疗方法。美沙拉嗪是轻中度溃疡性结肠炎治疗的基石，但尽管许多医生对此重视不足，药物治疗依从性差仍是一个严重的健康问题，会导致明显的疾病相关并发症。本研究旨在通过对文献进行系统评价和荟萃分析，评估溃疡性结肠炎患者口服美沙拉嗪的不依从程度。
在PubMed和Cochrane数据库中进行文献检索，查找报告成年溃疡性结肠炎患者口服美沙拉嗪不依从率的研究，并选择符合条件的研究进行评估。考虑研究类型（试验性研究与观察性研究）、地理区域、样本量、依从性评估方法和不依从率。
在总共464篇文章中，筛选后有34项研究纳入荟萃分析。16项研究（47%）为观察性研究，18项（53%）为临床试验。34项研究中，12项（35%）来自北美，14项（41%）来自欧洲，4项（12%）来自亚洲，4项（12%）来自世界混合地区。平均不依从率为32%，但各研究之间存在较大差异。特别是，观察性研究中的不依从率显著高于临床试验（分别为47%和20%，P<0.001），北美研究中的不依从率高于欧洲和亚洲研究（分别为54%、23%和4%，P<0.001）。
由于现有研究的异质性，文献中对口服美沙拉嗪不依从率的报道各不相同，但这是一个持续存在且常被忽视的问题，值得未来进一步研究。医生对单个患者采取个性化方法可提高药物治疗效果及溃疡性结肠炎患者的管理水平。
