P0692 MEDICATION ADHERENCE IN PEDIATRIC CROHN???S DISEASE

Abstract

Introduction: Despite the importance of medical therapy in treating Crohn’s Disease (CD), there is a lack of published data regarding medication adherence (MedAd) in children. Aims: 1) To determine the prevalence of adherence to prescribed mesalamine preparations (5ASA) and 6-mercaptopurine (6MP) or azathioprine (Aza) in children with CD. 2) To determine predictors of MedAd. 3) To evaluate parent, pt and physician perceptions of MedAd. Methods: Pts (<20 yrs) with CD taking oral 5ASA or 6MP/Aza for 6 mos prior to study entry. Data obtained included demographics, concurrent medications, PCDAI, and pharmacy records for the preceeding 6 mos. A validated formula was used to calculate prescription (Rx) refill rates (RRs). RR = Cumulative days’ supply obtained/Total days to next Rx fill ×100. “Adherence” was defined as RR >/=75%. Parents, pts and physicians completed short questionnaires regarding MedAd. Chi-Squared test, t-test, linear regression analyses and Kappa statistics were performed to identify statistical significance. Results: 53 pts were enrolled (33M:20F; 75%W:25%AA). Mean age 14.2 ± 3.2 yrs; median disease duration 23 mos. 87% of pts had been prescribed 5ASA, 72% 6MP/Aza, and 58% both. Median RRs: 5ASA 51%; 6MP/Aza 80%. 39.5% of pts were adherent to 5ASA and 54% adherent to 6MP/Aza. 72% of pts were off prednisone at time of enrollment. For pts on either 5-ASA or 6MP/Aza, being off prednisone significantly increased the RR (p=0.05). For pts taking both medication classes, the RR of one medication was highly predictive of the RR for the other (p<0.01). For 6MP/Aza, the RR was significantly higher if a parent (p=0.01) or pt (p=0.001) reported that the medication had been taken daily the previous week compared to <7d. Pts who said they were excellent or very good at taking their medications on average had an RR of 36% higher for 5ASA (p=0.04)and 54% higher for 6MP/Aza (p=0.001)than pts who reported their MedAd as fair or poor. Kappa statistics comparing parent and pt perceptions of MedAd were 0.57 for 5ASA and 0.69 for 6MP/Aza. Kappa statistics comparing physician perceptions with either parents or pts ranged from 0.28 to 0.45. Conclusion: Pediatric pts with CD have poor adherence to commonly prescribed medications. 6MP/Aza tended to have better adherence than mesalamine. Adherence to one medication class was significantly predictive of adherence to the other. Parents agreed relatively well with pts about pt mesalamine adherence and very well about pt 6MP/Aza adherence. Physician perceptions of adherence did not agree well with that of either parents or pts. The impact of poor adherence on disease outcomes in children with CD needs to be further addressed.