Kruis Wolfgang, Jessen Petra, Morgenstern Julia, Reimers Birgitta, Müller-Grage Nike, Bokemeyer Bernd
Department of Internal Medicine and Gastroenterology, Protestant Hospital Cologne-Kalk, Teaching Hospital of the University of Cologne, Cologne 51103, Germany.
Faculty of Medicine, University of Cologne, Cologne 50931, Germany.
World J Gastroenterol. 2025 Jun 14;31(22):101915. doi: 10.3748/wjg.v31.i22.101915.
Mesalamine is the recommended first-line treatment for inducing and maintaining remission in mild-to-moderate ulcerative colitis (UC). However, adherence in real-world settings is frequently suboptimal. Encouraging collaborative patient-provider relationships may foster better adherence and patient outcomes.
To quantify the association between patient participation in treatment decision-making and adherence to oral mesalamine in UC.
We conducted a 12-month, prospective, non-interventional cohort study at 113 gastroenterology practices in Germany. Eligible patients were aged ≥ 18 years, had a confirmed UC diagnosis, had no prior mesalamine treatment, and provided informed consent. At the first visit, we collected data on demographics, clinical characteristics, patient preference for mesalamine formulation (tablets or granules), and disease knowledge. Self-reported adherence and disease activity were assessed at all visits. Correlation analyses and logistic regression were used to examine associations between adherence and various factors.
Of the 605 consecutively screened patients, 520 were included in the study. The median age was 41 years (range: 18-91), with a male-to-female ratio of 1.1:1.0. Approximately 75% of patients reported good adherence at each study visit. In correlation analyses, patient participation in treatment decision-making was significantly associated with better adherence across all visits ( = 0.04). In the regression analysis at 12 months, this association was evident among patients who both preferred and received prolonged-release mesalamine granules (odds ratio = 2.73, = 0.001). Patients reporting good adherence also experienced significant improvements in disease activity over 12 months ( < 0.001).
Facilitating patient participation in treatment decisions and accommodating medication preferences may improve adherence to mesalamine. This may require additional effort but has the potential to improve long-term management of UC.
美沙拉嗪是诱导和维持轻至中度溃疡性结肠炎（UC）缓解的推荐一线治疗药物。然而，在现实环境中，其依从性往往不尽人意。鼓励患者与医护人员建立协作关系可能会促进更好的依从性和患者预后。
量化UC患者参与治疗决策与口服美沙拉嗪依从性之间的关联。
我们在德国的113家胃肠病科诊所进行了一项为期12个月的前瞻性非干预队列研究。符合条件的患者年龄≥18岁，确诊为UC，未接受过美沙拉嗪治疗，并提供了知情同意书。在首次就诊时，我们收集了人口统计学、临床特征、患者对美沙拉嗪剂型（片剂或颗粒剂）的偏好以及疾病知识等数据。在所有就诊时评估自我报告的依从性和疾病活动度。采用相关性分析和逻辑回归来检验依从性与各种因素之间的关联。
在连续筛查的605例患者中，520例纳入研究。中位年龄为41岁（范围：18 - 91岁），男女比例为1.1:1.0。约75%的患者在每次研究就诊时报告依从性良好。在相关性分析中，患者参与治疗决策与所有就诊时更好的依从性显著相关（ = 0.04）。在12个月时的回归分析中，这种关联在既偏好又接受缓释美沙拉嗪颗粒剂的患者中明显（优势比 = 2.73， = 0.001）。报告依从性良好的患者在12个月内疾病活动度也有显著改善（ < 0.001）。
促进患者参与治疗决策并顺应药物偏好可能会提高美沙拉嗪的依从性。这可能需要额外的努力，但有改善UC长期管理的潜力。
