IBD Study Characterizes Biologic Adherence, Confirms Nonadherence Risk Factors

Almost one-third of patients with inflammatory bowel disease (IBD) treated at academic centers with integrated specialty pharmacies may be nonadherent to biologic therapy, resulting in more emergency department visits and hospitalizations, based on a retrospective study.

Nonadherence became increasingly common in the presence of four previously reported risk factors, including smoking status, narcotic use, psychiatric history, and prior biologic use, reported lead author Lauren A. George, MD, of the University of Maryland, Baltimore, and colleagues.

"Identifying patients at risk for nonadherence is important to develop strategies to improve adherence," the investigators wrote in Gastro Hep Advances. "The aim of this analysis was to evaluate adherence across several academic centers with integrated specialty pharmacies, to assess if previously identified risk factors for nonadherence remained significant across several diverse IBD centers, and to evaluate outcomes associated with nonadherence."

Three tertiary care IBD clinics provided data from 608 patients with IBD. Inclusion required at least three consecutive prescription claims. All biologics were self-injectable, including adalimumab, certolizumab, golimumab, and ustekinumab.

Primary outcomes were medication possession ratio (MPR) and adherence, with nonadherence defined by an MPR lower than 0.86. Secondary outcomes included ED visits and hospitalizations.

After a median follow-up period of 903 days, the overall MPR was 0.95, with adherence of 68%-70%, which is considered "high," according to Dr. George and colleagues, as it exceeds previously reported national adherence rates.

"[Findings were] similar across all centers, geographic regions, and patient demographics," the investigators noted.

The four previously described risk factors did in fact predict nonadherence, with likelihood of nonadherence significantly increasing with each additional risk factor present. Patients with all four risk factors had less than 50% adherence.

Nonadherence was also significantly associated with more ED visits and hospitalizations, highlighting "the impact of biologic adherence on direct patient outcomes and healthcare costs," the investigators wrote.

"All healthcare industry stakeholders including healthcare systems, manufacturers, and third-party benefit providers need to understand the importance of improving patient adherence," Dr. George and colleagues concluded. "Decreasing barriers to self-injectable medication acquisition, increasing direct patient interaction with integrated pharmacy teams, and comprehensive patient education are a start to improving patient adherence. In addition, we propose that enhanced care pathways for patients with risk factors for nonadherence would improve adherence and outcomes."

No funding was reported. The investigators disclosed relationships with AbbVie, Janssen, UCB, and others.

This article originally appeared in GI and Hepatology News.

© 2023  Frontline Medical Communications Inc.

Cite this: IBD Study Characterizes Biologic Adherence, Confirms Nonadherence Risk Factors - Medscape - Jul 03, 2023.