Insight into the widespread problem of nonadherence to therapy in ulcerative colitis patients.

Ulcerative colitis is a chronic condition that requires long-term treatment. The first-line therapy remains 5-aminosalicylic acid, which is available in several different formulations and dosing schedules. Several studies have demonstrated that adherence rates to prescribed 5-aminosalicylic acid products are below those expected for a drug that has significant consequences on important outcomes. Worse disease outcomes, higher medical costs and even potentially higher rates of colorectal cancer have been associated with nonadherence. Nonadherence is multifactorial, fluid in nature over time and is dependent on disease activity level. Interventions to improve adherence rates have to be individualized. With the advent of simpler dosing regimens it was assumed that adherence rates would improve, but this has not been the case. Despite our current knowledge about nonadherence, it remains difficult to manage long term.