Adherence to Rectal Mesalamine in Patients with Ulcerative Colitis (UC)
Marie Boyle, Amanda Ting, Didia Cury, Kavinderjit Nanda, Adam Cheifetz, Alan Moss
Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Boston, MA,
Rectal mesalamine is an effective induction and maintenance therapy for ulcerative colitis (UC). Little is known about adherence to rectal mesalamine, or barriers to its use.
To quantify the prevalence of non-adherence to rectal mesalamine in practice, and to identify patient-reported barriers to adherence to rectal mesalamine.
A cohort of patients with UC was prospectively enrolled in this observational study and followed for 12 months. Adherence was assessed by tracking pharmacy refills (Medication Possession Ratio, MPR) during the follow-up period. Individual interviews were undertaken in a subset of subjects using a trained interviewer. Transcripts from the focus groups and interviews were analyzed to identify themes and links between these themes using qualitative data software (MaxQDA).
70 patients prescribed rectal mesalamine were prospectively enrolled in the study. At enrolment, 39/70 subjects (55%) self-reported “occasional non-adherence” to rectal mesalamine. Over the 12 months follow-up period, only 20 subjects (26%) completed 3 or more refills. Males, or subjects prescribed a once-a-day suppository, were significantly more likely to refill than females (OR 3.3 95% CI 1.1-10.9), or those prescribed suppositories more than once a day (OR 1.3, 95% CI 1.1-1.7). By MPR criteria, 71% of all subjects were non-adherent with their prescribed regimen (MPR <0.6). Non-adherers were significantly older than adherent subjects; mean age 48 years in non-adherers, vs. 37 in adherers, p=0.04. Patients who were non-adherent to rectal mesalamine frequently cited the mode of administration (65%) and busy lifestyle (40%) as reasons for intentional non-adherence.
Intentional non-adherence is very common in patients who have been prescribed rectal mesalamine. Gender, age, frequency of dosing and lifestyle factors may impact adherence to this form of mesalamine.