Factors Influencing Adherence to Mesalamine in Patients with Inflammatory Bowel Disease: A Patient-Reported Qualitative Analysis

Abstract

Purpose: The causes for non-adherence to mesalamine in patients with inflammatory bowel disease (IBD) have been characterized using mostly indirect methods. The goal of this study was to identify key factors influencing adherence to mesalamine in patients with ulcerative colitis (UC) and Crohn's disease (CD) through direct patient interviews. Methods: Patients were recruited from a single IBD center to participate in focus groups or one-on-one in-person interviews convened by a trained moderator. A standardized moderator guide was used that included open-ended questions to elicit patients' experiences with medication, adherence and factors affecting adherence. Data were collected until information saturation, the point where no new information could be collected, was attained. Transcripts were analyzed following the principles of Grounded Theory, using qualitative data analysis software, MAXQDA. Results: The sample consisted of 27 patients (4 focus groups totaling 17 patients and 10 one-on-one interviews). Twenty-one patients (78%) had UC and 6 (22%) had CD, and were combined in the analysis. Reported adherence ranged from complete adherence (n=3) to intermittent non-adherence (n=24). Four distinct patient-reported factors emerged from the interviews that motivated their adherence to mesalamine: desire to avoid a flare, perception about medication effectiveness in controlling the disease, regimen convenience (e.g. dosing schedule, number of pills) and development of an administration routine that fit with lifestyle. More intense or recent flares were reported to increase adherence. Almost all patients expressed a preference for fewer doses per day, ideally once daily, and most indicated this would improve adherence. The mid-day dose was frequently reported by participants to be problematic. In addition, patients indicated that absentmindedness, social embarrassment, refill inconvenience/cost, doubts about the need for mesalamine, and pill characteristics (size, numbers, side effects) were perceived as barriers to adherence. No substantial differences were observed between UC and CD patient-elicited themes. Conclusion: Key reported factors influencing mesalamine adherence in patients with IBD included desire to avoid a disease flare, regimen convenience and perception about medication effectiveness. Given these findings, education on the importance of taking medication, even in remission, should be emphasized. Practical solutions to trigger reminders, and simplified dosing schedules should also be considered in this patient population. Disclosure: Alan C Moss - Grant Support: Shire, Grant Support: Salix Kathleen Beusterien - Employee: Oxford Outcomes Adam S Cheifetz - Advisory Board: Warner-Chilcott Jennifer Devlen - Employee: Oxford Outcomes Linette Yen - Employee: Shire. This research was supported by an industry grant from Shire.