Background: We aimed to determine the rates and reasons for nonuse of inflammatory bowel disease (IBD)-specific medication in a referral clinic.
Methods: Consecutive persons with Crohn's disease (CD) (n = 423) and ulcerative colitis (UC) (n = 342) were followed in a single clinic over 2 years. At each patient visit, it was determined whether and what type of IBD-specific medications were used at that visit. If medications were not used, the reason for nonuse was recorded. Disease remission, further stratified by “clinical remission” and “deep remission” (clinical remission plus imaging evidence of remission), was considered a reason for nonuse if the attending physician believed the person was in remission and agreed for them to be off medications.
Results: Nonuse of IBD-specific medication was seen in 121 persons with CD (29%) and 65 persons with UC (18%). In CD, increased age and disease duration were associated with nonuse; disease phenotype did not predict nonuse. In UC, disease duration was associated with nonuse but age was not. In CD, the most common reason for medication nonuse was deep remission (22.5%), followed by clinical remission (21.4%), not having seen a gastroenterologist for a lengthy period (21.4%) and nonadherence (16%). In UC, nonuse was attributed to deep remission (27.7%), followed by nonadherence (26.3%) and clinical remission (23%).
Conclusions: Approximately a quarter of persons with IBD attending at a tertiary care practice do not use IBD-specific medications with a higher rate in CD than UC. The decision not to use medications was deemed appropriate in approximately one-half of all nonusers.
Article first published online 2 March 2016.
*Department of Internal Medicine, Section of Gastroenterology, IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada; and
†IBD Unit, Department of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Hospital, Jerusalem, Israel.
Reprints: Charles N. Bernstein, MD, University of Manitoba, 804F-715 McDermot Avenue, Winnipeg, MB, Canada R3E3P4 (e-mail: email@example.com).
H. Singh has consulted to Medical Cancer Screening Ltd. and has been on advisory board of Pendopharm. L. E. Targownik has consulted to or been on the advisory boards of: Takeda Canada, AbbVie Canada, and Janssen Canada. She has received research grant support from Pfizer Canada. She has been on the speakers' bureaus for Janssen Canada, Takeda Canada, and Pfizer Canada. C. N. Bernstein is supported in part by the Bingham Chair in Gastroenterology. He has consulted or served on advisory boards to AbbVie Canada, Shire Canada, Takeda Canada, Forrest Canada, Cubist Pharmaceuticals, Pfizer, Theradiag, and Mylan Pharmaceuticals. He has received educational grants from AbbVie Canada, Shire Canada, Takeda Canada, and Janssen Canada. He has been on speakers' bureau for AbbVie Canada and Shire Canada. The remaining authors have no conflict of interest to disclose.
Received December 11, 2015
Accepted January 25, 2016