X-ray diffraction study of inorganic structural units in fossil wood

Abstract

<h3>Background</h3> Adherence to maintenance 5-amino-salicylic-acid (5-ASA) therapy is associated with better health and quality of life of adolescents and young adults (AYA) diagnosed with Ulcerative Colitis (UC). However, little is known about rates of adherence and how often AYA discontinue oral 5-ASA treatment.¹ <h3>Aims</h3> To determine rates and predictors of oral 5-ASA adherence and risk of discontinuation amongst AYA diagnosed with UC. <h3>Methods</h3> A retrospective data analysis was performed within the UK Clinical Practice Research Datalink amongst AYA diagnosed with UC between 1998 and 2016 and and starting on oral 5-ASA treatment between the ages of 10 to 24 years. The proportion of individuals discontinuing treatment (first prescription gap of ≥ 90 days) in the first year of treatment and the median time until a first 90-day gap was estimated using Kaplan-Meier analysis. Adherence, measured as proportion of days covered (PDC) in the first year of treatment was calculated. Multivariable Cox and linear regressions assessed predictors associated with 5-ASA discontinuation and adherence, respectively. <h3>Results</h3> We identified 694 AYA initiated on oral 5-ASA treatment. The median time to 5-ASA discontinuation was 176 days (95% CI 153-204). A quarter of AYA stopped after a month of treatment and by a year 2 out of 3 individuals had discontinued. The proportion with continuous use of 5-ASA in the first year of treatment varied by age at initiation (10-14 years: 49%, 15-17 years: 52%, 18-24 years: 32% - Figure 1). The mean PDC was 73% (S.D. 0.31) in the first year of therapy and was lowest amongst individuals aged between 18 to 24 years, at 69% (S.D 0.32), compared to 81% (S.D 0.27) in 10 to 14 year olds and 79% amongst 15 to 17 year olds (S.D 0.30). Starting treatment between 18 and 24 years of age and socioeconomic deprivation increased the risk of discontinuation and lower adherence, while early corticosteroid use, a proxy marker of disease severity, was associated with a lower risk of discontinuation and better adherence. <h3>Conclusion</h3> AYA diagnosed with UC and initiated on oral 5-ASA medication are at risk early discontinuation and poor adherence. Clinicians should be vigilant regarding the higher risk following the first month of treatment, particularly in young adults and those living in deprived postcodes. Targeted interventions are needed to improve 5-ASA adherence among these high risk groups. <h3>Reference</h3> Spekhorst LM, <i>et al</i>. Adherence to oral maintenance treatment in adolescents with inflammatory bowel disease. <i>J. Pediatr. Gastroenterol. Nutr</i>. ( 2016).