We conducted a prospective study to determine the effects of nonadherence with mesalamine among patients with quiescent ulcerative colitis.
We followed a cohort of 99 consecutive patients who had ulcerative colitis in remission for more than 6 months and who were taking maintenance mesalamine. Medication adherence rates were calculated based on pharmacy records and a validated formula. Nonadherence was defined as refilling less than 80% of prescribed medication. Patients were followed prospectively and evaluated either in clinic or via telephone at 6, 12, and 24 months. The primary outcome was clinical recurrence of ulcerative colitis. Proportional hazards models were used to adjust for confounders.
At 6 months, 12 patients (12%) had clinical recurrence of disease symptoms, all of whom were nonadherent with medication. At 12 months, 19 of 86 patients had recurrent disease, 13 (68%) of whom were nonadherent. Patients who were not adherent with medication had more than a fivefold greater risk of recurrence than adherent patients (hazard ratio = 5.5; 95% confidence interval: 2.3 to 13; P < 0.001).
Nonadherence with medication increases the risk of clinical relapse among patients with quiescent ulcerative colitis. Future research should be directed at behavioral interventions to improve adherence.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The American Journal of Medicine
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Cigarette smoking and ulcerative colitis: a case-control study.Mayo Clin Proc. 1994; 69: 425-429
- Effects of smoking on the presentation and clinical course of inflammatory bowel disease.Eur J Gastroenterol Hepatol. 1997; 9: 683-687
- Stress and exacerbation in ulcerative colitis.Am J Gastroenterol. 2000; 95: 1213-1220
- Non-steroidal anti-inflammatory drugs are associated with emergency admission to hospital for colitis due to inflammatory bowel disease.Gut. 1997; 40: 619-622
- Effects of nonsteroidal antiinflammatory drugs on inflammatory bowel disease.Am J Gastroenterol. 2000; 95: 1949-1954
- An oral preparation of mesalamine as long-term maintenance therapy for ulcerative colitis. A randomized, placebo-controlled trial.Ann Intern Med. 1996; 124: 204-211
- Coated oral 5-aminosalicylic acid (Claversal) is equivalent to sulfasalazine for remission maintenance in ulcerative colitis.J Clin Gastroenterol. 1995; 21: 287-289
- Comparison of the efficacy and safety of 1.5 compared with 3.0 g oral slow-release mesalazine (Pentasa) in the maintenance treatment of ulcerative colitis.Eur J Gastroenterol Hepatol. 1995; 7: 1025-1030
- Maintenance of remission of ulcerative colitis.Aliment Pharmacol Ther. 1998; 12: 1207-1216
- Safety and efficacy of controlled-release mesalamine for maintenance of remission in ulcerative colitis.Dig Dis Sci. 1995; 40: 296-304
- Telephoning the patient’s pharmacy to assess adherence with asthma medications by measuring refill rate for prescriptions.J Pediatr. 2000; 136: 532-536
- A comparison study of multiple measures of adherence to HIV protease inhibitors.Ann Intern Med. 2001; 134: 968-977
- Observational studies of antihypertensive medication use and compliance: is drug choice a factor in treatment adherence?.Curr Hypertens Rep. 2000; 2: 515-524
- Predictors of non-compliance with mesalamine in quiescent ulcerative colitis.Am J Gastroenterol. 2001; 96: 2929-2932
- Clinical features, course, laboratory findings, and complications in ulcerative colitis.in: Kirsner J.B.M. Inflammatory Bowel Disease. W. B. Saunders, Baltimore, Maryland2000: 299-305
- The Short Inflammatory Bowel Disease Questionnaire.Am J Gastroenterol. 1996; 91: 1571-1578
- A general method of compliance assessment using centralized pharmacy records. Description and validation.Med Care. 1988; 26: 814-823
- The magnitude of compliance and noncompliance.in: Haynes R.B. Sackett D.L. Compliance in Health Care. Johns Hopkins Press, Baltimore, Maryland1979: 19-27
- Cortisone in ulcerative colitis.BMJ. 1955; 2: 1041-1044
- Why do patients with ulcerative colitis relapse?.Gut. 1990; 31: 179-183
- The assessment of refill compliance using pharmacy records.J Clin Epidemiol. 1997; 50: 105-116
- Clinical, biological, and histological parameters as predictors of relapse in ulcerative colitis.Gastroenterology. 2001; 120: 13-20
- Course of ulcerative colitis.Gastroenterology. 1994; 107: 3-11
- Evaluation of clinical patterns in ulcerative colitis.Int J Clin Pharmacol Res. 1997; 17: 17-22
- Controlled trial of sulphasalazine in maintenance therapy for ulcerative colitis.Lancet. 1965; 1: 185-189
- A randomized controlled trial of an enhanced patient compliance program for Helicobacter pylori therapy.Arch Intern Med. 1999; 159: 2312-2316
- Increasing patient adherence to gastroenterology treatment and prevention regimens.Am J Gastroenterol. 1999; 94: 1733-1742
☆This research was funded by grants from Procter and Gamble Pharmaceuticals, Cincinnati, Ohio, and the David and Reva Logan Center for Gastrointestinal Research, Chicago, Illinois.
© 2003 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.