Parfenov AI, Knyazev OV, Babayan AF, Kagramanova АV. Low adherence to treatment is a weak link in the problems of ulcerative colitis. Terapevticheskii Arkhiv (Ter. Arkh.). 2021;93(12):1419–1427.
DOI: 10.26442/00403660.2021.12.201172
Низкая приверженность лечению – слабое звено в цепи проблем язвенного колита
Parfenov AI, Knyazev OV, Babayan AF, Kagramanova АV. Low adherence to treatment is a weak link in the problems of ulcerative colitis. Terapevticheskii Arkhiv (Ter. Arkh.). 2021;93(12):1419–1427.
DOI: 10.26442/00403660.2021.12.201172
Цель. Выявить факторы приверженности лекарственной терапии больных язвенным колитом (ЯК), связанные с пациентом. Материалы и методы. Исследование выполнено в отделении лечения воспалительных заболеваний кишечника ГБУЗ «МКНЦ им. А.С. Логинова» с 2019 по 2021 г. путем анкетирования 1089 пациентов с ЯК. Выявляли пациентов с высокой (ВПТ) и низкой приверженностью терапии (НПТ). Результаты. По данным анкетирования пациентов с НПТ оказалось 596 (59,6%), с ВПТ – 404 (40,4%); р<0,001. В группе ВПТ (100%) преобладали женщины – 297 (73,5%); р<0,001, пациенты с длительностью ЯК более 5 лет – 305 (75,5%) и внекишечными проявлениями – 261 (64,6%); р<0,001. В группе НПТ все больные имели вредные привычки, не соблюдали диету и были моложе 44 лет (р<0,001). Частота обострений ЯК более 1 раза год была выше в группе НПТ – 430 (72,1%) пациентов против 137 (33,9%) пациентов в группе ВПТ (р<0,001). Частота хирургических операций в группе НПТ – 12 (2,0%), в группе ВПТ – 2 (0,5%); р<0,001. Заключение. Среди пациентов с ЯК около 60% имели НПТ. С ВПТ достоверно ассоциируются женщины, проживающие в семье, неработающие, имеющие внекишечные проявления и право на бесплатное лекарственное обеспечение. С НПТ связаны мужчины с высшим образованием в возрасте до 44 лет, с осложненным течением ЯК, получающие системные глюкокортикостероиды, имеющие вредные привычки (курение, алкоголь).
Aim. To determine factors of adherence to treatment in patients with ulcerative colitis (UC). Materials and methods. The study was performed in the department of treatment of inflammatory bowel diseases in Loginov Moscow Clinical Scientific Center from 2019 till 2021 years by surveying 1089 patients with UC. This analysis revealed patients with high adherence (HAP) and low adherence to treatment (LAP). Results. In the survey analysis was determined, that there were more low-adherence patients, than high-adherence patients [596 (59.6%) and 404 (40.4%), respectively, (р<0.001)]. In the group of HAP (100%) were 297 women (73.5%) and 107 (26.5%) men (р<0.001). Also in this group prevailed patients with duration of disease more 5 years 305 (75.5%) and extraintestinal manifestations – 261 (64.6%); р<0.001. In the group of LAP (100%) were more patients younger 44 years, with bad habits and who did not follow diet (р<0.001). The rate of UC reccurence more than 1 time per year was higher in LAP group – 430 (72.1%), versus 137 (33.9%) patients in HAP (р<0.001). The frequency of surgical procedures in UC patients was significantly higher in LAP – 12 (2.0%) in comparison with 2 (0.5%) in HAP group (р<0.001). Conclusion. In our study was determined, that among UC patients, examined in the department of inflammatory bowel diseases, 60% patients had low adherence to treatment. High adherence to the treatment is statistically significantly associated with female gender, family accommodation, non-working patients, extraintestinal manifestations, additional medical maintenance. Low adherence to the treatment is associated with steroids, male gender, age less than 44 year, bad habits (smoking, alcohol consumption), higher education, complicated UC and frequency of reccurences.
Keywords: inflammatory bowel disease, adherence to therapy, ulcerative colitis
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DOI:10.1111/1751-2980.12539
21. Van der Have M, Oldenburg B, Kaptein AA, et al. Nonadherence to Anti-TNF Therapy is Associated with Illness Perceptions and Clinical Outcomes in Outpatients with Inflammatory Bowel Disease: Results from a Prospective Multicentre Study. J Crohns Colitis. 2016;10:549-55. DOI:10.1093/ecco-jcc/jjw002
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DOI:10.1097/00005650-198601000-00007
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27. Парфенов А.И., Каграманова А.В., Бабаян А.Ф., Князев О.В. Приверженность терапии больных с воспалительными заболеваниями кишечника. Терапевтический архив. 2018;90(12):4-11 [Parfenov AI, Kagramanova AV, Babayan AF, Knyazev OV. Adherence to the therapy in patients with inflammatory bowel diseases. Terapevticheskii Arkhiv (Ter. Arkh.). 2018;90(12):4-11 (in Russian)].
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32. Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med. 1987;317(26):1625-9. DOI:10.1056/NEJM198712243172603
33. World Medical Association Declaration of Helsinki Ethical Principles for Medical Research Involving Human Subjects. World Medical Association. JAMA. 2013;310(20):2191-4. DOI:10.1001/jama.2013.281053
34. Ambaw AD, Alemie GA, Yohannes SMW, Mengesha ZB. Adherence to antihypertensive treatment and associated factors among patients on follow up at University of Gondar Hospital, Northwest Ethiopia. BMC Public Health. 2012;12(1):282. DOI:10.1186/1471-2458-12-282
35. Wong MC, Jiang JY, Griffiths SM. Factors associated with antihypertensive drug compliance in 83,884 Chinese patients: a cohort study. J Epidemiol Community Health. 2010;64(10):895-901. DOI:10.1136/jech.2009.091603
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________________________________________________
1. Khat'kov IE, Parfenov AI, Kniazev OV, et al. Vospalitel'nye zabolevaniia kishechnika v praktike terapevta i khirurga. Moscow: Vita-PRESS, 2017 (in Russian).
2. World Health Organization. Adherence to long-term therapies: evidence for action. WHO Library Cataloguing-in-Publication Data, Geneva, WHO, 2003.
3. Lukina JV, Kutischenko NP, Martcevich SJ. Adherence to therapy: current state of problem. Cardiovascular Therapy and Prophylaxis. 2017;16(1):91-5 (in Russian).
DOI:10.15829/1728-8800-2017-1-91-95
4. Chowdhury R, Khan H, Heydon E, et al. Adherence to cardiovascular therapy: a metaanalysis of prevalence and clinical consequences. Eur Heart J. 2013;34:2940-8. DOI:10.1093/eurheartj/eht295
5. Parfenov AI, Kagramanova AV, Babayan AF, Knyazev OV. Adherence to the therapy in patients with inflammatory bowel diseases. Terapevticheskii Arkhiv (Ter. Arkh.). 2018;90(12):4-11 (in Russian). DOI:10.26442/00403660.2018.12.000001
6. Harbord M, Eliakim R, Bettenworth D, et al. Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 2: Current Management. J Crohns Colitis. 2017;11(7):769-84. DOI:10.1093/ecco-jcc/jjx009
7. Kane SV, Cohen RD, Aikens JE, et al. Prevalence of nonadherence with maintenance mesalamine in quiescent ulcerative colitis. Am J Gastroenterol. 2001;96:2929-33. DOI:10.1111/j.1572-0241.2001.04683.x
8. Moody GA, Jayanthi V, Probert CS, et al. Long-term therapy with sulphasalazine protects against colorectal cancer in ulcerative colitis: a retrospective study of colorectal cancer risk and compliance with treatment in Leicestershire. Eur J Gastroenterol Hepatol. 1996;8:1179-83. DOI:10.1097/00042737-199612000-00009
9. Shale MJ, Riley SA. Studies of compliance with delayed-release mesalazine therapy in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2003;18:191-8. DOI:10.1046/j.1365-2036.2003.01648.x
10. Van Hees PA, van Tongeren JH. Compliance to therapy in patients on a maintenance dose of sulfasalazine. J Clin Gastroenterol. 1982;4:333-6.
DOI:10.1097/00004836-198208000-00008
11. Bloomfeld RS, Onken JE. Mercaptopurine metabolite results in clinical gastroenterology practice. Aliment Pharmacol Ther. 2003;17:69-73. DOI:10.1046/j.1365-2036.2003.01392.x
12. Bokemeyer B, Teml A, Roggel C, et al. Adherence to thiopurine treatment in out-patients with Crohn's disease. Aliment Pharmacol Ther. 2007;26:217-25.
DOI:10.1111/j.1365-2036.2007.03365.x
13. Mantzaris GJ, Roussos A, Kalantzis C, et al. How adherent to treatment with azathioprine are patients with Crohn's disease in long-term remission? Inflamm Bowel Dis. 2007;13:446-50. DOI:10.1002/ibd.20041
14. Wright S, Sanders DS, Lobo AJ, et al. Clinical significance of azathioprine active metabolite concentrations in inflammatory bowel disease. Gut. 2004;53:1123-8. DOI:10.1136/gut.2003.032896
15. Peyrin-Biroulet L, Sandborn W, Sands BE, et al. Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol. 2015;110:1324-38. DOI:10.1038/ajg.2015.233
16. Hanauer SB, Feagan BG, Lichtenstein GR, et al. Maintenance infliximab for Crohn's disease: the ACCENT I randomised trial. Lancet. 2002;359:1541-9.
DOI:10.1016/S0140-6736(02)08512-4
17. Sands BE, Anderson FH, Bernstein CN, et al. Infliximab maintenance therapy for fistulizing Crohn's disease. N Engl J Med. 2004;350:876-85.
DOI:10.1056/NEJMoa030815
18. Rutgeerts P, Sandborn WJ, Feagan BG, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2005;353:2462-76. DOI:10.1056/NEJMoa050516.
19. Lopez A, Billioud V, Peyrin-Biroulet C, et al. Adherence to anti-TNF therapy in inflammatory bowel diseases: a systematic review. Inflamm Bowel Dis. 2013;19:1528-33. DOI:10.1097/MIB.0b013e31828132cb
20. Martelli L, Lopez A, Strobel S, et al. Adherence to infliximab therapy in inflammatory bowel disease patients in a real-life setting. J Digest Dis. 2017;18(10):566-73.
DOI:10.1111/1751-2980.12539
21. Van der Have M, Oldenburg B, Kaptein AA, et al. Nonadherence to Anti-TNF Therapy is Associated with Illness Perceptions and Clinical Outcomes in Outpatients with Inflammatory Bowel Disease: Results from a Prospective Multicentre Study. J Crohns Colitis. 2016;10:549-55.
DOI:10.1093/ecco-jcc/jjw002
22. Kane S, Huo D, Aikens J, et al. Medication nonadherence and the outcomes of patients with quiescent ulcerative colitis. Am J Med. 2003;114:39-43.
DOI:10.1016/s0002-9343(02)01383-9
23. Kane SV, Chao J, Mulani PM. Adherence to infliximab maintenance therapy and health care utilization and costs by Crohn's disease patients. Adv Ther. 2009;26:936-46. DOI:10.1007/s12325-009-0069-7
24. Babayan AF, Knyazev OV, Kagramanova AV, et al. Adherence to the therapy in patients with inflammatory bowel diseases in Moscow Clinical Scientific centre named A.S. Loginov. Russian Journal of Evidence-Based Gastroenterology. 2020;9(12):40 (in Russian).
25. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67-74.
DOI:10.1097/00005650-198601000-00007
26. Trindade AJ, Ehrlich A, Kornbluth A, Ullman TA. Are your patients taking their medicine? Validation of a new adherence scale in patients with inflammatory bowel disease and comparison with physician perception of adherence. Inflamm Bowel Dis. 2011;17:599-604. DOI:10.1002/ibd.21310
27. Parfenov AI, Kagramanova AV, Babayan AF, Knyazev OV. Adherence to the therapy in patients with inflammatory bowel diseases. Terapevticheskii Arkhiv (Ter. Arkh.). 2018;90(12):4-11 (in Russian). DOI:10.26442/00403660.2018.12.000001
28. Marcevich SJ, Kutischenko NP, Tolpigina SN, et al. Recommendations Russian Society of cardiologists. Efficacy and safety of medication by primary and secondary prophylaxis of cardiovascular diseases. Moscow, 2011 (in Russian).
29. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67:361-70. DOI:10.1111/j.1600-0447.1983.tb09716.x
30. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002;52(2):69-77. DOI:10.1016/s0022-3999(01)00296-3
31. Ivashkin VT, Shelygin YuA, Belousova EA, et al. Project: Clinical guidelines for the diagnostics and treatment of ulcerative colitis. Koloproktologia. 2019;18(4):7-36
(in Russian). DOI:10.33878/2073-7556-2019-18-4-7-3
32. Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med. 1987;317(26):1625-9. DOI:10.1056/NEJM198712243172603
33. World Medical Association Declaration of Helsinki Ethical Principles for Medical Research Involving Human Subjects. World Medical Association. JAMA. 2013;310(20):2191-4. DOI:10.1001/jama.2013.281053
34. Ambaw AD, Alemie GA, Yohannes SMW, Mengesha ZB. Adherence to antihypertensive treatment and associated factors among patients on follow up at University of Gondar Hospital, Northwest Ethiopia. BMC Public Health. 2012;12(1):282. DOI:10.1186/1471-2458-12-282
35. Wong MC, Jiang JY, Griffiths SM. Factors associated with antihypertensive drug compliance in 83,884 Chinese patients: a cohort study. J Epidemiol Community Health. 2010;64(10):895-901. DOI:10.1136/jech.2009.091603
36. Fodor GJ, Kotrec M, Bacskai K, et al. Is interview a reliable method to verify the compliance with antihypertensive therapy? An international central-European study. J Hypertens. 2005;23(6):1261-6. DOI:10.1097/01.hjh.0000170390.07321.ca
37. Akpa MR, Agomuoh DI, Odia OJ. Drug compliance among hypertensive patients in Port Harcourt, Nigeria. Niger J Med. 2005;14(1):55-7. DOI:10.4314/njm.v14i1.37136
38. Hussanin SM, Boonshuyar C, Ekram ARMS. Non-Adherence To Antihypertensive Treatment in Essential Hypertensive Patients in Rajshahi, Bangladesh. Anwer Khan Modern Medical College Journal. 2011;2(1):9-14. DOI:10.3329/akmmcj.v2i1.7465
39. Ageev FT, Fofanova TV, Kadushina EB, et al. The effect of the presence of a drug in the list of additional drug support on the adherence to its intale by outpatient patients with arterial hypertension. Cardiology. 2011;51(6):21-5 (in Russian).
40. Khokhlov AL, Lisenkova LA, Rakov AA. Analysis of factors, determing adherence to antihypertensive therapy. Good Clinical Practice. 2003;4:59-66 (in Russian).
41. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487-97. DOI:10.1056/NEJMra050100
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1 ГБУЗ «Московский клинический научно-практический центр им. А.С. Логинова» Департамента здравоохранения г. Москвы,
Москва, Россия;
2 ФГБУ «Государственный научный центр колопроктологии им. А.Н. Рыжих» Минздрава России, Москва, Россия;
3 ГБУ «Научно-исследовательский институт организации здравоохранения и медицинского менеджмента» Департамента здравоохранения г. Москвы, Москва, Россия
*oleg7@bk.ru
________________________________________________
Asfold I. Parfenov1, Oleg V. Knyazev*1–3, Anait F. Babayan1, Аnna V. Kagramanova1
1 Loginov Moscow Clinical Scientific Center, Moscow, Russia;
2 Ryzikh State Scientific Center for Coloproctology, Moscow, Russia;
3 Research Institute of Healthcare Organization and Medical Management, Moscow, Russia
*oleg7@bk.ru