Abstract
Material and methods: All pts receiving biologics were included in the study. Cause and length of delay/anticipation respect to scheduled administration were considered. Adherence to ADA was assessed using patient diaries. The mean duration of biological therapy was 16.5 months (1-61). Pts: 136, 60M/76F, 110CD/26UC, mean age at diagnosis 32.4 (20-73) and at 1st administration 40.5 (16-78). IFX was administered to 93/136 pts (68.4%) and ADA to 43/136 (31.6%). Indications to biologicals were: steroiddependence/resistance in 91/136 (66.9%), fistulae in 35/136 (25.8%), AZA failure in 6/136 (4.4%) others in 4/136 (2.9%). The overall number of administrations was 1763 (mean 12.9/pt, range1-73). Results: A total of 187/1763 administrations (10.6%) in 45 pts (33%) was delayed [29 IFX (32.6%), 16 ADA (43.2%) (p=0.3)]. The mean number of delayed administrations was 2.2 and the delay 13.7 days (1-35). Forgetfulness, summer holidays, pharmaceutical supply and intentional non adherence were responsible for 294 days delay (28 pts). Adverse events were responsible for 198 days delay (18 pts). A total of 82/1763 administrations (4.65%) were anticipated in 14 pts, (13 on IFX -92.8%and 1 on ADA -7.2%p<0.01), with a mean of 2.05 events/pt and an anticipation vs scheduled timing of 7.8 days (1-28). The reason for anticipation was related to practical issues in 19 (23.2%), occurrence of articular pain in 1 (1.2%) and lost response/active disease in 62 (75.6%) administrations. A clinical need and not a lack of adherence justify anticipation in these last 62 patients. Conclusions: About 30% of patients failed to adhere strictly to scheduled treatment with biologics, in 10.6% of administrations. Possible consequences of reduced compliance remain to be assessed. Interestingly, in this study lack of adherence has been found also with agents which do not require daily and/or multiple administrations. No difference has been found between IFX and ADA in terms of decreased adherence.
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