N17 Exploration of medication non-adherence in Inflammatory Bowel Disease patients: A systematic review

Abstract

Inflammatory bowel disease (IBD) has recognised medications to maintain remission and prevent relapse. Yet between 53–75% of people with IBD do not take medications as prescribed. Identifying and improving medication adherence in IBD is a primary treatment goal to keep symptoms quiescent. This systematic review aims to identify why people are adherent and non-adherent to IBD medications. Studies exploring medication adherence for IBD conducted between 2012-2022, were identified in six electronic databases. The quality of quantitative and qualitative studies was assessed using a scoring system or the Critical Appraisal Skills Programme, respectively. 39,603 participants were included across 79 studies investigating IBD medication adherence, mainly from single outpatient clinic populations, using cross-sectional surveys. Most data were quantitative, rated medium quality. Few studies were based around a theory to explain adherence. Non-adherence was most typically measured using a version of the Morisky Medication Adherence Scale or the study’s own self-report questionnaire, with non-adherence ranging from 4.3%-88.9%. In multivariable analysis of quantitative data, younger age and female gender were usually associated with non-adherence. The presence of smoking, psychological issues (depression, treatment concerns, anxiety) or lower social status were also significant non-adherence risk factors. Most typically investigated were clinical variables, many being significantly related with non-adherence, including medication type (specifically 5-ASA), route (oral, rectal, subcutaneous, intravenous), high and low disease activity and poor disease/medication knowledge. Significant results were often contradictory between studies, as was the relationship direction with non-adherence. Forgetting medication was the main reason for non-adherence in qualitative interviews, with side effects, costs, medication concerns and busy lifestyle also variables. Cohort-specific factors were reported for non-adherence in pregnant women, adolescents and patients during COVID.Conclusion Adherence to treatment is essential in IBD. Yet a large and confusing literature exists regarding factors underpinning non-adherence. Clinicians should be aware of those non-modifiable factors, to help identify relevant patients and support their treatment programme. Potentially modifiable factors including medication regimes, route and patient knowledge, could be targeted to improve adherence in IBD. Theoretically informed interventions need to be developed. A successful evidence-based intervention supporting medication adherence could help improve quality of life for patients living with IBD, whilst providing patient-centred care and minimising health costs.