Maria Cristina Leoni1, Linde Amelung2, Faydra I Lieveld3, Janneke van den Brink3, Joep de Bruijne3, Joop E Arends4, Carel-Peter van Erpecum5, Karel J van Erpecum6. 1. Department of Gastroenterology and Hepatology, University Medical Center Utrecht Affiliated to Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, University of Pavia, p.le Golgi 19, 27100 Pavia, Italy. 2. Department of Gastroenterology and Hepatology, University Medical Center Utrecht Affiliated to Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Department of Internal medicine and Infectious diseases, University Medical Center Utrecht Affiliated to Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. 3. Department of Gastroenterology and Hepatology, University Medical Center Utrecht Affiliated to Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. 4. Department of Internal medicine and Infectious diseases, University Medical Center Utrecht Affiliated to Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. 5. University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. 6. Department of Gastroenterology and Hepatology, University Medical Center Utrecht Affiliated to Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. Electronic address: k.j.vanerpecum@umcutrecht.nl.
Abstract
BACKGROUND: Ursodeoxycholic acid (UDCA) is used for treatment of cholestatic liver diseases and may improve long-term outcome. Although treatment with this hydrophilic bile acid is virtually without side effects, medication adherence might be suboptimal due to patient misconceptions, compromising clinical outcome. Our aim was to evaluate adherence to UDCA in relation to patient beliefs about medicine and to identify potential predictors of poor adherence. METHODS: Prospective open-label study recruiting patients in treatment with UDCA from April 2016 to March 2017. Adherence was assessed both by the Sensemedic dispenser and by patient-reported adherence, during 12 weeks. Good adherence was defined as ≥ 80% intake. Quality of life (by SF-36) and beliefs about medicine (by BMQ) were also assessed. RESULTS: A total of 75 patients were enrolled (32% primary biliary cholangitis, 31% autoimmune hepatitis, 29% primary sclerosing cholangitis and 8% other conditions). Average adherence according to the medication dispenser was 92 ± 16% (range: 17-100). Eighty-nine percent of the patients exhibited good adherence and 11% poor adherence. According to the BMQ, 42% of all patients were accepting, 50% ambivalent, 8% indifferent and 0% skeptical to UDCA treatment. Poor adherence was associated with young age (P = 0.029) and male gender (P = 0.021). CONCLUSIONS: Despite the excellent safety profile of UDCA, still a significant number of patients are poorly adherent. Young age and male sex are associated with poor adherence. Efforts should be made to identify patients with poor adherence and to improve their compliance to therapy.
BACKGROUND:Ursodeoxycholic acid (UDCA) is used for treatment of cholestatic liver diseases and may improve long-term outcome. Although treatment with this hydrophilic bile acid is virtually without side effects, medication adherence might be suboptimal due to patient misconceptions, compromising clinical outcome. Our aim was to evaluate adherence to UDCA in relation to patient beliefs about medicine and to identify potential predictors of poor adherence. METHODS: Prospective open-label study recruiting patients in treatment with UDCA from April 2016 to March 2017. Adherence was assessed both by the Sensemedic dispenser and by patient-reported adherence, during 12 weeks. Good adherence was defined as ≥ 80% intake. Quality of life (by SF-36) and beliefs about medicine (by BMQ) were also assessed. RESULTS: A total of 75 patients were enrolled (32% primary biliary cholangitis, 31% autoimmune hepatitis, 29% primary sclerosing cholangitis and 8% other conditions). Average adherence according to the medication dispenser was 92 ± 16% (range: 17-100). Eighty-nine percent of the patients exhibited good adherence and 11% poor adherence. According to the BMQ, 42% of all patients were accepting, 50% ambivalent, 8% indifferent and 0% skeptical to UDCA treatment. Poor adherence was associated with young age (P = 0.029) and male gender (P = 0.021). CONCLUSIONS: Despite the excellent safety profile of UDCA, still a significant number of patients are poorly adherent. Young age and male sex are associated with poor adherence. Efforts should be made to identify patients with poor adherence and to improve their compliance to therapy.