EC Gastroenterology and Digestive System

Introduction: Non-adherence is a problem in the treatment of chronic diseases including idiopathic inflammatory bowel diseases (IBD) and, according to the literature, adherence is insufficient in a quarter of patients. This results in a risk of therapy failure and relapse. This factor plays a significant role in self-administration of subcutaneous biological therapy (BT). The objective of the paper is the evaluation of adherence of IBD patients on subcutaneous BT who were monitored conventionally in comparison with the use of telemedicine monitoring means.

Methodology: Adherence was evaluated on the basis of retrospective data of a single centre regarding the frequency of visits and the medication dispensed to patients registered on the IBD Asistent platform involving active sending of notifications with reminders to administer the medication and calculating the Medication Possession Ratio (MPR). The control group consisted of conventionally monitored patients comparable in terms of the treatment type, diagnosis, sex and age. A secondary primary point was the serum levels of the medication in the subpopulation of patients treated with adalimumab.

Results: The study involved 69 patients on subcutaneous BT, active in the period from July 2022 to July 2023 on the IBD Asistent platform. Matched to this group at a ratio of 2:1, there was a control group of 138 conventionally monitored patients. The average age of the patients was 40.6 ± 11.1 years, 43.5% of the patients were men. Crohn disease was diagnosed in 83.1% patients. 91.3% of patients were treated with adalimumab, 7.2% of patients received subcutaneous vedolizumab, and 1.5% of patients were treated with golimumab. The median monitoring time was 517 days. The adherence evaluated by means of MPR was high both in the telemedicine and conventional groups (0.960 ± 0.084 vs. 0.967 ± 0.094; p = 0.6123). The rate of non-adherent patients with MPR below 0.86 was 8.8% and 8.0%, respectively (p = ns). In the whole patient population, the adherence was significantly lower in women and a tendency towards higher adherence was seen in patients with ulcerative colitis. The age of patients played no role. Among patients with low levels of adalimumab, the rate of non-adherent patients was considerably higher (36.8% vs. 4.9%; p = 0.0002).

Conclusion: Although the overall adherence to a subcutaneous BT is relatively high and independent of the method of patient monitoring, MPR evaluation may help identify risk groups of patients. Low levels of the medication result from non-adherence in a third of the cases.

 Keywords: Idiopathic Inflammatory Bowel Diseases (IBD); Biological Therapy (BT); Medication Possession Ratio (MPR); IBD Asistent Platform

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