P074  Prevalence and Associated Factors with Nonadherence to Maintenance Therapy for Ulcerative Colitis in Deep Remission

P074  Prevalence and Associated Factors with Nonadherence to Maintenance Therapy for Ulcerative Colitis in Deep Remission


 

Franco Fernanda1, Oliveira Mirella1, Franco Danielle1, Gaburri Pedro2, Chebli Liliana1, Chebli Julio1
1 Federal University of Juiz de Fora, Juiz de Fora, Brazil, 2 UFJF, Juiz de Fora, Brazil

BACKGROUND: Ulcerative colitis (UC) is a chronic lifelong disease that can drastically affect the individual's quality of life and, therefore, the adherence to treatment is very important in order to keep it in remission. We aimed to evaluate the prevalence and associated factor of non-adherence to therapy with oral drugs for UC in deep remission. 

METHODS: A cross-sectional study was conducted between August 2017 and January 2018 with 90 adult outpatients with UC in deep remission from a tertiary IBD center.  A semi-structured questionnaire with socio-demographic and clinical questions was applied and scores on instruments eight-item Morisky Medication Adherence Scale (MMAS-8), Beck Depression Inventory and the Hopitalar Anxiety and Depression Scale was recorded. Patients who presented a cut point of ≥ 6 on the MMAS-8 were classified as adherent to pharmacotherapy, while those with scores less than 6 were classified as non-adherent.

RESULTS: A total of 90 patients were included to participate of evaluation. The epidemiological profile found showed gender equivalence (50% male), age 50.4 ± 12.9 years, white (81.1%), with some degree of literacy (n = 87, 96.7%), engaged in paid work (n = 69, 76.7%), and married or in a consensual marriage (54.4%). Compensated comorbidities were present in 46 individuals (51.1%). The prevalence of depression and anxiety was 15.6% and 36.7%, respectively. The prevalence of non-adherence was 77.8% and the socio-demographic variables that were related to the non-adherence behavior were younger age and not being engaged in paid work. In particular it was noticed that younger individuals and those who were not engaged in paid work were 2.6 and 4.3 times, respectively, more likely to have non-adherence behavior. In addition, anxiety was also a significant factor that tripled the chance of have had a non-adherence behavior. Considering the clinical features of UC, no characteristics was found to impact with non-adherence behavior. The most prescribed oral medication for maintenance of remission in UC patients was mesalazine (54.4%) followed by sulfasalazine (38.9%) and azathioprine (37.8%). It was noticed that the number of classes of drugs used influenced the non-adherence behavior, and the patients who had taken only one type of medication were more adherent than those who used two or more drug classes (i.e., polypharmacy; p=0.04). Nonetheless, neither the number of pills taken daily nor the specific medication used for UC influenced in non-adherence behavior (p=0.11 and p=0.48, respectively). 

CONCLUSION(S): We identified a high prevalence of non-adherence behavior to treatment with oral drugs in patients with UC in deep remission. In particular, younger patients, who were not engaged in paid work, with symptoms of anxiety and those on polypharmacy were identified as having the highest risk for non-adherence behavior.  Identifying the factors influencing its occurrence is of paramount importance for the development of strategies by health care professionals aiming to improve adherence to therapy, assuring that the best outcome will be achieved in order to maintain deep remission in UC.