Medication Adherence Aligns with Age and a Behavioral Checklist but Not Symptoms or Quality of Life for Patients with Eosinophilic Esophagitis

Abstract

To measure adherence rates to swallowed topical steroids in children with eosinophilic esophagitis (EoE), describe factors related to adherence, and determine the association between adherence, symptoms, perceived disease severity, and quality of life in children with EoE. Subjects in this cross-sectional study of 117 children between 5 and 18years old with EoE completed the Pediatric Eosinophilic Esophagitis Symptoms Score V2.0 (PEESS), Pediatric Quality of Life InventoryEosinophilic Esophagitis Module (PedsQL EoE), a Medication-Taking Checklist (MTC), and a demographics questionnaire. Adherence rate was calculated based on reported number of missed doses/prescribed doses in the last week. Parent-reported measures were used for children aged 5-12years and self-report was used for children aged 13-18years. Adolescents had lower adherence rates than younger children (76.2±24.5% vs 88.6±16.7%, P=.002). Adherence rates were not associated with disease history, PEESS, or PedsQL EoE scores but instead correlated with MTC scores (Pearson r of 0.65, P<.001 for child-report and Pearson r of 0.74, P<.001 for parent-report). Symptomatology was associated with worse quality of life (PEESS Frequency: r=-0.7, P<.001; PEESS Severity: r=-0.71, P<.001 for children 5-12years old; PEESS Frequency: r=-0.61, P<.001; PEESS Severity: r=-.5, P<.001 for adolescents). Unrelated to their clinical history, demographic factors, symptoms, and quality of life, adolescents with EoE have lower medication adherence rates. The MTC may serve as a clinical tool to discuss adherence and provide targeted educational counseling regarding adherence interventions.