Long-term oral mesalazine adherence and the risk of disease flare in ulcerative colitis: nationwide 10-year retrospective cohort from the veterans affairs healthcare system
Alimentary Pharmacology and Therapeutics, 08/10/2012
Khan N et al. – Long–term high–adherence level was lower than previously reported. Adherence was a significant factor in predicting disease flares. Pharmacy adherence indicators may be useful to healthcare providers in identifying patients at high risk of exacerbations.Methods
- Nationwide data were obtained from the VA for the period 2001-2011.
- UC patients who started mesalazine maintenance during the inclusion period were included.
- Level of adherence was assessed using three different indicators: medication possession ratio (MPR), continuous single-interval medication availability (CSA) and continuous multiple-interval medication gaps (CMG).
- Cox regression modelling was used to predict disease flares and assess the predictive value of each adherence indicator.
- The authors included 13 062 patients into the analysis with median follow-up time of 6.1 years.
- Percentage of patients with high adherence was 47%, 43%, 31% as identified by CSA, MPR and CMG respectively.
- Low adherers had a significant increase in the risk of flares compared with high adherers (Hazard ratio: 2.8, 1.7 and 1.8, P < 0.001 for CSA, MPR and CMG, respectively).
- Compared with other adherence indicators, CSA offered the best trend in predicting disease flares.