Wunsch Ewa, Krause Linda, Lohse Ansgar Wilhelm, Schramm Christoph, Löwe Bernd, Uhlenbusch Natalie, Snijders Romée, Willemse José, Janik Maciej, Gevers Tom J G, Milkiewicz Piotr
Division of Gastroenterology, Department of Translational Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland.
RARE-LIVER European Reference Network, Brussel, Belgium.
United European Gastroenterol J. 2025 Aug 1. doi: 10.1002/ueg2.70083.
Non-adherence to treatment may be one of the most important causes for the failure of therapy goals in autoimmune liver diseases (AILD). We aimed to assess factors related to non-adherence in adult non-transplanted patients with autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC).
A cross-sectional online survey was conducted in patients with AILD who were prescribed pharmacotherapy for liver disease. Adherence was defined as skipping their medication less than once a week and never reducing or stopping their medication themselves. Sociodemographic data were analyzed relating to medication and disease-related factors in the context of adherence. Multivariable logistic regression analyses were used to identify factors associated with adherence while adjusting for known confounders. A total of 1097 patients with AILD were included: 444 patients with AIH, 377 with PBC and 276 with PSC. Patients with AIH were the most non-adherent group (47%), in comparison to those suffering from PBC (29%), and PSC (38%). In multivariable logistic regression models, over-the-counter medication use was identified as one important common factor that was negatively associated with treatment adherence in all patients and most relevant in the case of the AIH group. Among standard treatments, steroids, though not azathioprine, were negatively associated with adherence in the AIH group.
This anonymous survey revealed high non-adherence in patients with AILD, particularly those with AIH treated with steroids. Over-the-counter medication intake may reflect low treatment confidence in standard treatments and should be carefully assessed in patients with AILD in a clinical setting.
治疗依从性差可能是自身免疫性肝病（AILD）治疗目标失败的最重要原因之一。我们旨在评估成年非移植自身免疫性肝炎（AIH）、原发性胆汁性胆管炎（PBC）和原发性硬化性胆管炎（PSC）患者中与治疗依从性差相关的因素。
对接受肝病药物治疗的AILD患者进行了横断面在线调查。依从性定义为每周漏服药物少于一次，且从未自行减少或停止用药。分析了社会人口统计学数据与依从性背景下的用药和疾病相关因素之间的关系。使用多变量逻辑回归分析来确定在调整已知混杂因素后与依从性相关的因素。共纳入1097例AILD患者：444例AIH患者、377例PBC患者和276例PSC患者。与PBC患者（29%）和PSC患者（38%）相比，AIH患者是依从性最差的组（47%）。在多变量逻辑回归模型中，非处方药物的使用被确定为一个重要的共同因素，与所有患者的治疗依从性呈负相关，在AIH组中最为相关。在标准治疗中，AIH组中，类固醇（而非硫唑嘌呤）与依从性呈负相关。
这项匿名调查显示AILD患者的依从性较差，尤其是接受类固醇治疗的AIH患者。非处方药物的摄入可能反映出对标准治疗的信心不足，在临床环境中应对AILD患者进行仔细评估。
