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Adherence to adalimumab therapy in Crohn's disease: A French multicenter experience

Billioud, Vincent MD1; Laharie, David MD, PhD2; Filippi, Jérôme MD3; Roblin, Xavier MD4; Oussalah, Abderrahim MD1; Chevaux, Jean-Baptiste MD1; Hébuterne, Xavier MD, PhD3; Bigard, Marc-André MD1; Peyrin-Biroulet, Laurent MD, PhD1

doi: 10.1002/ibd.21491
Original Clinical Articles

Background: We evaluated adherence to adalimumab therapy in Crohn's disease (CD).

Methods: This was an observational multicenter study conducted in four French university hospitals between April 4, 2008 and January 1, 2010. Patients were systematically asked, at each clinical visit, whether or not they delayed or missed an injection of adalimumab over the past 3 months. Patients were also asked about the reasons for their nonadherence.

Results: Of the 108 patients analyzed, 33 (30.6%) delayed the administration of at least one injection and 16 (14.8%) missed at least one injection over the past 3 months. The main reasons for overall nonadherence were: forgetfulness (24.6%), infection (24.6%), and travel (20%). Other reasons for nonadherence were intentional nonadherence (10.8%), pharmaceutical supply issues (9.2%), side effects (7.7%), pregnancy (1.5%), and CD-related hospitalization (1.5%). Adalimumab regimen of 40 mg every other week was a positive predictor for injection delays (P = 0.02, odds ratio [OR] = 3.76, 95% confidence interval [CI], 1.28–11.05), whereas having at least one relapse in the past 12 months was associated with fewer delays (P = 0.02, OR = 0.37, 95% CI, 0.15–0.87). [correction made here after initial online publication]. Disease duration over 90 months negatively predicted failure to inject adalimumab (P = 0.009, OR = 0.17, 95% CI, 0.05–0.64).

Conclusions: The overall nonadherence rate for adalimumab use was 45.4%. Most of the reasons for nonadherent behaviors could be avoided. An adalimumab regimen of 40 mg every other week was negatively related to adalimumab adherence; both the occurrence of at least one relapse in the past 12 months and disease duration over 90 months were positively related to adherence. (Inflamm Bowel Dis 2011;)

1Inserm, U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France

2Gastroenterology and Hepatology Unit, Haut-Lévêque Hospital, Pessac, France

3Department of Gastroenterology and Clinical nutrition, University Hospital of Nice, Archet 2 Hospital, Nice, France

4Department of Hepato-Gastroenterology, University Hospital of Saint-Etienne, Saint-Etienne, France

Reprints: Department of Hepato-Gastroenterology, University Hospital of Nancy-Brabois, Allée du Morvan, 54511 Vandoeuvre-lès-Nancy, France

Additional supporting information may be found in the online version of this article.


Received 25 July 2010; Accepted 17 August 2010

This article was published online November 8th, 2010. An error was subsequently identified. This notice is included in the online and print versions to indicate that both have been corrected.

© Crohn's & Colitis Foundation of America, Inc.
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