Patterns and Predictors of Long-term Nonuse of Medical Therapy Among Persons with Inflammatory Bowel Disease

• Published in: Inflammatory bowel diseases 2015-07, Vol.21 (7), p.1615-1622
• Main Authors: Melesse, Dessalegn Y, Targownik, Laura E, Singh, Harminder, Blanchard, James F, Bernstein, Charles N
• Format: Article
• Language: English
• Subjects: Adult; Aged; Female; Follow-Up Studies; Humans; Incidence; Inflammatory Bowel Diseases - epidemiology; Inflammatory Bowel Diseases - therapy; Male; Manitoba - epidemiology; Middle Aged; Patient Compliance; Prevalence; Retrospective Studies; Risk Factors; Time Factors; Treatment Refusal - statistics & numerical data; Young Adult
• ISSN: 1078-0998; 1536-4844
• DOI: 10.1097/MIB.0000000000000418

To evaluate patterns and predictors of long-term nonuse of inflammatory bowel disease (IBD)-specific medications among patients with IBD. All incident cases of IBD diagnosed between 1987 and 2012 were identified from the population-based University of Manitoba IBD Epidemiology Database. Point prevalence of long-term medication nonuse (defined as no receipt of IBD-specific medications for a year or longer) was determined over calendar time and the course of disease. Cox proportional hazard regression analysis was performed to identify factors associated with delayed initiation and with becoming a long-term nonuser. Among 6451 persons with IBD followed since 1987 (46.8% male, 47.8% with Crohn's disease), 11.7% were not dispensed an IBD-specific medication within the first year and 6.2% within 5 years after diagnosis. Factors associated with delayed initiation included having Crohn's disease (hazard ratio [HR] = 0.78, 95% confidence interval [CI], 0.73-0.83), lower socioeconomic status (HR = 0.91, 95% CI, 0.84-0.98), age more than 65 years (HR = 0.76, 95% CI, 0.67-0.86), and having any medical comorbidity. The prevalence of long-term nonuse consistently remained between 40% and 50% of persons with IBD across the study years. Patients with Crohn's disease (HR = 1.14, 95% CI, 1.04-1.25), lower socioeconomic status (HR = 1.14, 95% CI, 1.02-1.27), patients with IBD-associated surgery (HR = 1.72, 95% CI, 1.51-1.96), or delayed initiation of first IBD medication were more likely to become long-term nonusers after initiation. At any given time, roughly half of all patients with IBD have not used IBD-specific medications in the previous year. Further work is required to evaluate the clinical implications of long-term medication nonuse in IBD.