Original Article

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

  1. N. Khan1,2,*,
  2. A. M. Abbas1,2,
  3. L. A. Bazzano3,4,
  4. Y. N. Koleva1,
  5. M. Krousel-Wood3,4

Article first published online: 8 AUG 2012

DOI: 10.1111/apt.12013

Issue

Alimentary Pharmacology & Therapeutics

Alimentary Pharmacology & Therapeutics

Volume 36, Issue 8, pages 755–764, October 2012

Additional Information

How to Cite

Aliment Pharmacol Ther 2012; 36: 755–764

Author Information

  1. 1

    Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA

  2. 2

    Section of Gastroenterology and Hepatology at Tulane University Health Sciences Center, New Orleans, LA, USA

  3. 3

    Department of Epidemiology and of Medicine at Tulane University Health Sciences Center, New Orleans, LA, USA

  4. 4

    Center for Health Research at Ochsner Health System, New Orleans, LA, USA

* Correspondence to:
Dr N. Khan, Tulane University School of Medicine, 1430 Tulane Avenue, SL35, New Orleans, LA 70112, USA.
E-mails: nabeel.khan@va.gov; nkhan2@tulane.edu

Publication History

  1. Issue published online: 17 SEP 2012
  2. Article first published online: 8 AUG 2012
  3. Manuscript Accepted: 18 JUL 2012
  4. Manuscript Revised: 12 JUL 2012
  5. Manuscript Revised: 21 JUN 2012
  6. Manuscript Received: 23 MAY 2012

Funded by

  • Department of Veterans Affairs
  • Veterans Health Administration
  • Office of Research & Development Health Services R&D. Grant Number: 425

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Summary

Background

Adherence is a major factor in determining disease activity in ulcerative colitis (UC). There are limited data on long-term nationwide adherence levels among patients with UC.

Aim

To evaluate the long-term adherence levels to oral mesalazine (mesalamine) in the Veterans Affairs (VA) healthcare system, to determine the impact of non-adherence on the risk of flares, and to evaluate the different pharmacy data-based adherence indicators.

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.

Results

We 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.

Conclusions

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.

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