Abstract
Aim To determine the risk factors of nonadherence to azathioprine (AZA) maintenance therapy for Crohn's disease (CD) and to evaluate the influence of patients' educational program on adherence to AZA maintenance therapy. Methods Patients receiving AZA as maintenance therapy for CD were enrolled. Demographic data, clinical data, and usage information were collected. Univariate and multivariate analyses were performed to identify the risk factors of nonadherence. Then, patients' educational program was conducted. One year after the program, the improvements in adherence and relapse rates were compared between educational and noneducational groups. Results A total of 378 CD patients receiving AZA as maintenance therapy were enrolled from September 2008 to September 2018. Nonadherence occurred in 43.9% (166/378) of patients. Univariate analysis revealed that young age, education, alcoholism, anxiety, depression, concern belief, and lack of necessity belief and AZA knowledge were risk factors of nonadherence (P < 0.05). Multivariate logistic regression showed that anxiety (OR 6.244, 95% CI 2.563–15.213), depression (OR 3.801, 95% CI 1.281–11.278), and concern belief (OR 19.531, 95% CI 3.393–120.732) were independent risk factors of nonadherence. Necessity belief (OR 0.961, 95% CI 0.925–0.999) and AZA knowledge (OR 0.823, 95% CI 0.758–0.903) were protective factors of adherence. One year after the AZA educational program, the necessity belief, AZA knowledge, and adherence of the educational group significantly improved (P < 0.05). Concern belief was significantly lower in the educational group than that in the noneducational group (P < 0.05). Moreover, the noneducational group suffered significantly higher endoscopic relapse rates than that the educational group (15.9% vs. 30.1%, P = 0.035). Conclusions Nonadherence occurred frequently in CD patients receiving AZA maintenance therapy. Educational programs could improve patients' adherence mainly by promoting their beliefs and knowledge of AZA and could reduce relapse rates during treatment.
Highlights
Crohn’s disease (CD) is a chronic inflammatory disease that is characterized by periods of remission and relapse and has an unpredictable course [1]
A total of 378 CD patients who received AZA as maintenance therapy from September 2008 to September 2018 were enrolled in our study
We found that patients’ low necessity belief and AZA knowledge and high concern belief were risk factors of nonadherence to AZA usage (P < 0:05) (Table 1)
Summary
Crohn’s disease (CD) is a chronic inflammatory disease that is characterized by periods of remission and relapse and has an unpredictable course [1]. Unlike Western countries, immunosuppressants, such as azathioprine (AZA), remain a mainstay in long-term maintenance therapy in developing countries, including China, where biological agents are not covered by medical insurance in most areas [3,4,5]. Improving adherence during maintenance therapy is of great importance in long-term CD management [10]. Nonadherence to AZA maintenance therapy for CD has not been fully explored, especially in China. Further identifying the risk factors of nonadherence and investigating potential ways to improve adherence may be considerably important in CD maintenance therapy. We analyzed the medication adherence of CD patients to AZA maintenance therapy and determined the influence of educational programs on adherence and disease outcomes
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