IBD

12 - Risk Factors for Medication Non-Adherence to Biologic Therapy in Patients With Inflammatory Bowel Disease: A Retrospective Analysis

Monday, October 8
2:25 PM - 2:35 PM
Location: Terrace Ballroom 4 (level 400)

Category: IBD
Jennifer Haydek, BS1, Nisha B. Shah, PharmD1, James Slaughter, PhD1, Jonathan R. Ashton, Jr., BS2, Autumn Zuckerman, PharmD1, Rochelle Wong, BS1, Francesca Raffa, MD1, Ailish Garrett, NP1, Caroline Duley, NP1, Kim Annis, PA1, Julianne Wagnon, JD, NSN, FNP-BC3, Lawrence Gaines, PhD1, Robin Dalal, MD1, Elizabeth Scoville, MD, MSCI1, Dawn B. Beaulieu, MD1, David Schwartz, MD1, Sara N. Horst, MD, MPH1
1Vanderbilt University Medical Center, Nashville, TN; 2Vanderbilt Specialty Pharmacy, Nashville, TN; 3Vanderbilt IBD Center, Nashville, TN

Introduction: In inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), adherence to biologic therapy is critical. Prior research has demonstrated that a medication possession ratio (MPR) of less than 0.86 significantly increases the risk of disease flare. (1) Further understanding of the risk factors for non-adherence is needed.

Methods: We conducted a retrospective study to evaluate patients (pts) treated at a tertiary care IBD center prescribed injectable biologic therapy (adalimumab, certolizumab, golimumab, or ustekinumab) and followed by the center’s specialty pharmacy (defined as at least 3 prescription claims). MPR was calculated as the sum of days’ supply for all prescription claims divided by the total number of days (d) elapsed during the study period. Medication non-adherence was defined as MPR < 0.86. Wilcoxon test was used for continuous variables, Pearson testing for categorical variables in univariate analysis.

Results: In this study, 460 pts (n=393 with CD and n=67 with UC) were evaluated. Table 1 summarizes patient characteristics. Median follow up was 921 d (range 232, 1414 d). The overall mean MPR was 0.89. In this cohort, 69% of pts were adherent (MPR > 0.86), 71% of pts with CD and 87% of pts with UC.

Several risk factors were shown to increase the risk of non-adherence in univariate analysis including a diagnosis of CD, insurance type, psychiatric history, smoking, prior biologic use, and narcotic use (Table 2). Disease type and past surgical history in CD did not have an impact on adherence.

Using multivariate analysis, insurance type (Medicaid) (OR 5.5, CI 1.85, 15.6) and diagnosis of CD (OR 2.8, CI 1.3, 6.0) increased the risk of noncompliance, but several risk factors trended toward significance. In pts with CD, as the number of risk factors present increased (narcotic use, psychiatric diagnosis history, prior biologic use, and smoking), the probability of non-adherence significantly increased. (Figure 2) Adherence was 77% and 73% in patients with 0 to 1 risk factors, decreasing to 65%, 61% and 37% in those with 2, 3, or 4 risk factors respectively (p < 0.05).

Discussion: This study identified several risk factors for non-adherence to injectable biologic therapy. Additionally, as number of risk factors increased in pts with CD, the probability of adherence to therapy significantly decreased.

1. Govani S, Noureldin M, Higgins P, et al. Am J Gastroenterol. 2018;113:276.

Table 1. Patient Characteristics
Table 2. Risk Factors for non-adherence in pts with IBD on injectable biologic medication
Figure 1. The probability of adherence in pts with CD decreases as the number of risk factors increase (risk factors include prior biologic use, narcotic use, psychiatric history, and smoking; p < 0.05).

Disclosures:
Jennifer Haydek indicated no relevant financial relationships.
Nisha Shah indicated no relevant financial relationships.
James Slaughter indicated no relevant financial relationships.
Jonathan Ashton indicated no relevant financial relationships.
Autumn Zuckerman indicated no relevant financial relationships.
Rochelle Wong indicated no relevant financial relationships.
Francesca Raffa indicated no relevant financial relationships.
Ailish Garrett indicated no relevant financial relationships.
Caroline Duley indicated no relevant financial relationships.
Kim Annis indicated no relevant financial relationships.
Julianne Wagnon indicated no relevant financial relationships.
Lawrence Gaines indicated no relevant financial relationships.
Robin Dalal indicated no relevant financial relationships.
Elizabeth Scoville indicated no relevant financial relationships.
Dawn Beaulieu: Abbvie – Consultant. Janssen – Consultant. Takeda – Consultant.
David Schwartz: Abbvie – Advisory Committee/Board Member, Consultant, Speaker's Bureau. genentech – Advisory Committee/Board Member, Consultant. Gilead – Advisory Committee/Board Member. Janssen – Advisory Committee/Board Member, Consultant. Takeda – Advisory Committee/Board Member, Consultant, Grant/Research Support, Speaker's Bureau. UCB – Advisory Committee/Board Member, Consultant.
Sara Horst: Janssen – Consultant.

Sara Horst

Associate Professor
Vanderbilt University Medical Center
Nashville, Tennessee

Sara Horst, MD, MPH, is an Associate Professor of Medicine at Vanderbilt University Medical Center. She has expertise in the field of inflammatory bowel disease and has been active in patient care and clinical research since joining faculty in 2011. Her research interests include innovative treatment strategies for severe inflammatory bowel disease and psychological outcomes including depression in inflammatory bowel disease. She is active on national committees, has served on the Patient Education Committee for the Crohn’s and Colitis Foundation and is currently serving on the Professionalism Committee for the ACG and on the expert panel for the ACG Women in GI Circle. She is a reviewer for journals including Inflammatory Bowel Diseases, Clinical Gastroenterology and Hepatology, and Alimentary Therapeutics and Pharmacology. Dr. Horst completed her Internal Medicine residency and Chief residency at The Ohio State University and Gastroenterology fellowship and Masters of Public Health at Vanderbilt University Medical Center.

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