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5-ASA MEDICATION COMPLIANCE: A QUESTION OF PREFERENCE
I Sutcliffe1, N Saloojee2, A Sekar2, D Patel2, R Sy2
1Department of Medicine, University of Ottawa, Ottawa, Ontario; 2Department of Gastroenterology, University of Ottawa, Ottawa, Ontario
Aminosalicylates (5-ASA) are the mainstay of therapy for induction and maintenance of remission in inflammatory bowel disease (IBD). Previous studies suggest high rates of non-adherence to 5-ASA therapy, often leading to higher relapse rates. Our aim was to identify the determinants of non compliance in the medical management of IBD patients.
METHODS: Appropriate patients with IBD and on 5-ASA therapy were asked to complete a questionnaire regarding their preference to various characteristics of taking medications that may affect compliance.
RESULTS: One hundred questionnaires were completed. Fourteen patients were not on 5-ASA and excluded. In the 86 questionnaires eligible for analysis, the average age of participants was 42.9 y, 61% are married and 54% completed a university level education. 68% of patients had ulcerative colitis and the average duration of IBD was 114 months. Significantly more patients favored capsules over tablets (53% vs 23%, p<0.05). Pill frequency, size and cost were the most limiting factors in taking pills (27, 17, 11% respectively). Pill frequency was chosen significantly more than all other causes, with no significant attributable differences in age, sex, marital status, number of medications or education (p<0.05). In a choice between pill size or frequency, 60% felt frequency was more important, while only 21% chose pill size and 19% were indifferent. When asked to choose among combinations of pill size and frequency as it relates to 5-ASA, two large pills daily (30%) was the most significant dosing regime chosen, followed by two medium pills BID (18%). Irrespective of pill size, patients preferred daily (55%) over BID (37%) or QID (8%) dosing.
CONCLUSION: Pill frequency, size and costs are significant limitation to 5-ASA therapy, with frequency being the most significant factor to compliance. Our findings support current advances in 5-ASA therapy which allow for once a day dosing to optimize compliance in long term medical management of IBD.