RETRACTED: P444 Shared decision making for switching from oral mesalazine tablets to granules in low adherent inflammatory bowel disease patients.
J Crohns Colitis. 2018 Jan 16;12(suppl_1):S329
Authors: Kato S, Kani K, Ishibashi A, Oka M, Nagoshi S, Yakabi K
BACKGROUND: Oral mesalazine effectively induces and maintains remission in inflammatory bowel diseases (IBD) patients. However, adherence to the drug regimen is low. Shared decision-making (SDM) is considered effective in promoting treatment adherence in IBD patients. We used SDM to switch non-adherent IBD patients from oral mesalazine tablets to granules and checked the new adherence rates.
METHODS: The IRB of our hospital approved this observational study named ‘Evaluation of improvement of adherence by changing oral mesalazine to Pentasa granule in low adherent inflammatory bowel disease patients, IMPACT-PG’. We used the Morisky Medication Adherence Scale (MMAS-8, where an MMAS-8 score of ≥6 indicates good adherence) to assess adherence to oral mesalazine. We met with low adherence patients and explained the benefits and characteristics of mesalazine granules and tablets; we then gave them a choice between continuing with the same pH-dependent mesalazine tablets (with a 20% weight/volume decrease) and switching to oral mesalazine granules (2 g in one stick, 2 g once or twice a day). Primary endpoint was adherence rate in IBD patients with granule or with tablet at 6 months, and secondary endpoint was adherence rate at 12 months. Contributing factors to good adherence to the oral regimen were also examined. The adherence rate was analysed using chi-square test, and contributing factors were determined by multivariate analysis using SPSS ver24.
RESULTS: One hundred and eighty-three patients (126 UC and 57 Crohn’s colitis patients) were enrolled and examined adherence by MMAS-8 score. Good adherence ratio was 42.6% (78 of 183). Both higher age and low frequency of medication were significantly more common in adherent patients than in non-adherent patients. Odds ratios of age and the frequency of daily medication were 1.057 (95% CI 1.029-1.086; p < 0.0001) and 0.407 (95% CI 0.218-0.759; p = 0.005), respectively. SDM was performed to the 105 low adherence patients. 67% of the low adherence patients (70 of 105) preferred mesalazine granules. Five patients were dropped out until 6 months, as well as 13 patients were dropped out until 12 months. Remission rates at 0, 6, and 24 months were not significantly different between granule and tablet groups. Adherence rates at 6 [67% (44/66) vs. 32% (11 of 34)] and at 12 [72% (43 of 60) vs. 44% (14 of 32)] months were significantly higher in the granule group than in the tablet group.
CONCLUSIONS: SDM was effective for switching patients from a mesalazine tablet to a granule regimen, and adherence rates were improved in IBD patients.
PMID: 31135895 [PubMed – in process]