Commitment to treatment of inflammatory bowel disease

Inflammatory bowel diseases (IBD) are chronic autoimmune inflammatory diseases with intestinal damage and extraintestinal manifestations. The concept of permanent life-long medication is the cornerstone in the treatment of IBD. Adherence to drugs is defined as the degree to which the patient observes the dose and the interval between them in accordance with the prescribed dosage regimen. Unfortunately, in general, in chronic diseases, adherence decreases over time, reaching 50 % in developed countries and even more in developing ones. Objective. To assess adherence to therapy in patients with Crohn's disease (CD) and ulcerative colitis (UC), observed in the department for the treatment of inflammatory bowel diseases at the Moscow Clinical Scientific and Practical Centre n.a. A.S. Loginov. Materials and methods. The study included 55 (45.8 %) men and 65 (54.2 %) women older than 18 years, 70 (58.3 %) patients with UC, 50 (41.7 %) with CD, who were treated and examined in the department of treatment of inflammatory bowel disease of the centre. Patient adherence to therapy was evaluated using the Moriska-Green test, the results of which were used to divide all patients into two groups: first, patients with low treatment adherence (LTA); the second is with high commitment (HTA). Results. It was found that patients with low adherence to therapy turned out to be significantly more than patients with high: 78 (65.0 %) vs. 42 (35.0 %), respectively (p < 0.001). In the group of patients with HTAs, women prevailed: 26 (61.9 %) versus 16 (30.1 %) (p < 0.001). In the group of HTAs, patients with BC also prevailed: 30 (71.4 %) versus 12 (28.6 %) patients with UC (p < 0.001). It was established that in the group of HTAs, patients receiving 5-aminosalicylic acid preparations (5-ASA) prevailed 23 (54.8 %) and genetically engineered biological preparations (GIBP): 15 (35.7 %). In the LTA group, patients receiving systemic immunosuppressants and glucocorticosteroids prevailed at 54 (69.3 %) versus patients receiving 5-ASA and GIBP at 24 (30.7%) (p < 0.001). The frequency of exacerbations of diseases more than once a year was significantly higher in the LTA group at 52 (66.6 %) versus 13 (30.9 %) in the HTA group (p < 0.001). The incidence of surgical interventions in patients with CD was significantly higher in the LTA group - 15 (75.0 %) versus 5 (16.6 %) in the HTA group (p < 0.001). A significant difference between the groups was noted, if possible, to receive drugs in the SDS list (supplementary drug supply) - 38 (90.5 %) in the HTA group versus 40 (51.3 %) in the LTA group (p < 0.001). It is established that the form of mesalazine also affects the adherence to therapy. It has also been shown that adherence is not affected by the patient s age and socioeconomic status. Conclusion. Among patients with IBD, examined in the department of treatment of inflammatory bowel disease of Moscow Clinical Scientific and Practical Centre n.a. A. S. Loginov, 65 % have a low commitment to taking prescribed medications. Such factors as the use of systemic immunosuppressors and glucocorticosteroids in therapy, the complicated course of CD, an increase in the frequency of exacerbations of IBD are associated with a low adherence to treatment. The female sex, the presence of drugs in the SDS list, and the convenience of therapy are reliably associated with high treatment adherence.

Crohn's disease, inflammatory bowel disease, adherence, ulcerative colitis