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Clinical Predictors of Future Nonadherence in Inflammatory Bowel Disease

Severs, Mirjam MD1; Mangen, Marie-Josée J. PhD2,3; Fidder, Herma H. MD, PhD1; van der Valk, Mirthe E. MD, PhD1; van der Have, Mike MD, PhD1; van Bodegraven, Ad A. MD, PhD4,5; Clemens, Cees H. M. MD, PhD6; Dijkstra, Gerard MD7; Jansen, Jeroen M. MD, PhD8; de Jong, Dirk J. MD, PhD9; Mahmmod, Nofel MD, PhD10; van de Meeberg, Paul C. MD, PhD11; van der Meulen-de Jong, Andrea E. MD, PhD12; Pierik, Marieke MD, PhD13; Ponsioen, Cyriel Y. MD, PhD14; Romberg-Camps, Marielle J. L. MD, PhD5; Siersema, Peter D. MD1,9; Jharap, Bindia MD, PhD15; van der Woude, Janneke C. MD, PhD16; Zuithoff, Nicolaas P. A. PhD2; Oldenburg, Bas MD, PhD1

doi: 10.1097/MIB.0000000000001201
Original Clinical Articles

Background: Nonadherence to medical therapy is frequently encountered in patients with inflammatory bowel disease (IBD). We aimed to identify predictors for future (non)adherence in IBD.

Methods: We conducted a multicenter prospective cohort study with adult patients with Crohn's disease (CD) and ulcerative colitis (UC). Data were collected by means of 3-monthly questionnaires on the course of disease and healthcare utilization. Medication adherence was assessed using a visual analogue scale, ranging from 0% to 100%. Levels <80% were considered to indicate nonadherence. The Brief Illness Perception Questionnaire was used to identify illness perceptions. We used a logistic regression analysis to identify patient- and disease-related factors predictive of nonadherence 3 months after the assessment of predictors.

Results: In total, 1558 patients with CD and 1054 patients with UC were included and followed for 2.5 years. On average, 12.1% of patients with CD and 13.3% of patients with UC using IBD-specific medication were nonadherent. Nonadherence was most frequently observed in patients using mesalazine (CD), budesonide (UC) and rectally administrated therapy (both CD and UC). A higher perceived treatment control and understanding of the disease were associated with adherence to medical therapy. Independent predictors of future nonadherence were age at diagnosis (odds ratio [OR]: 0.99 per year), nonadherence (OR: 26.91), a current flare (OR: 1.30) and feelings of anxiety/depression (OR: 1.17), together with an area under the receiver-operating-characteristics curve of 0.74.

Conclusions: Lower age at diagnosis, flares, feelings of anxiety or depression, and nonadherence are associated with future nonadherence in patients with IBD. Altering illness perceptions could be an approach to improve adherence behavior.

Article first published online 11 July 2017.

1Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands;

2Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands;

3Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands;

4Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands;

5Department of Gastroenterology and Hepatology (Co-MIK), Zuyderland Medical Center, Heerlen, Sittard, Geleen, the Netherlands;

6Department of Gastroenterology and Hepatology, Diaconessenhuis, Leiden, the Netherlands;

7Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands;

8Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands;

9Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands;

10Department of Gastroenterology and Hepatology, Antonius Hospital, Nieuwegein, the Netherlands;

11Department of Gastroenterology and Hepatology, Slingeland Hospital, Doetinchem, the Netherlands;

12Department of Gastroenterology and Hepatology, Leiden University Medical Center, the Netherlands;

13Department of Gastroenterology and Hepatology, Maastricht University Medical Center, the Netherlands;

14Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands;

15Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, the Netherlands; and

16Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands.

Address correspondence to: Bas Oldenburg, MD, PhD, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands (e-mail:

The COIN-study was supported by an unrestricted grant from AbbVie.

Author disclosures are available in the Acknowledgments.

Received December 23, 2016

Accepted April 18, 2017

© Crohn's & Colitis Foundation
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