Prevalence of nonadherence with maintenance mesalamine in quiescent ulcerative colitis

OBJECTIVE: There are scant data regarding outpatient adherence in quiescent ulcerative colitis aside from patients enrolled in controlled clinical tri als. We conducted a prevalence study to determine the medication adherence rate of maintenance therapy and to identify possible risk factors for nonad herence. METHODS: Outpatients with clinically quiescent ulcerative colitis for >6 mo nths on maintenance mesalamine (Asacol, Procter and Gamble, Cincinnati, OH) were eligible. Patients were interviewed regarding disease history, and de mographics were obtained from medical records. Refill information for at le ast 6 months was obtained from computerized pharmacy records. Adherence was defined as at least 80% consumption of supply dispensed. Using nonadherenc e as the outcome of interest, stratified analysis and regression modeling w ere used to identify significant associations. RESULTS: Data were complete for the 94 patients recruited. The overall adhe rence rate was found to be 40%. The median amount of medication dispensed p er patient was 71% (8-130%) of the prescribed regimen. Nonadherent patients were more likely to be male (67% vs 52%, p < 0.05), single (68% vs 53%, p = 0.04), and to have disease limited to the left side of the colon versus p ancolitis (83% vs 51%, p < 0.01). Sixty-eight percent of patients who took more than four prescription medications were found to be nonadherent versus only 40% of those patients taking fewer medications (p = 0.05). Age, occup ation, a family history of inflammatory bowel disease, length of remission, quality-of-life score, or method of recruitment (telephone interview vs cl inical visit) were not associated with nonadherence. Logistic regression id entified that a history of more than four prescriptions (odds ratio [OR] 2. 5 [1.4-5.7]) and male gender (OR 2.06 [1.17-4.88]) increased the risk of no nadherence. Two statistically significant variables, which were protective against nonadherence, were endoscopy within the past 24 months (OR 0.96 [0. 93-0.99]) and being married (OR 0.46 [0.39-0.57]). CONCLUSION: Nonadherence is associated with multiple concomitant medication s, male gender, and single status. These patient characteristics may be hel pful in targeting those patients at higher risk for nonadherence. (Am J Gas troenterol 2001;96:2929-2933. (C) 2001 by Am. Coll. of Gastroenterology).