N018 Nursing intervention improves medication adherence to thiopurines in IBD outpatients: A single-centre prospective study

• Published in: Journal of Crohn's and colitis Vol. 12; no. supplement_1; p. S576
• Main Authors: Okuda, M, Sakagami, K, Matsumoto, M, Ito, H, Shinzaki, S
• Format: Journal Article
• Language: English
• Published: UK Oxford University Press 16-01-2018
• ISSN: 1873-9946; 1876-4479
• DOI: 10.1093/ecco-jcc/jjx180.1032

Abstract
Background
Thiopurines are widely used immunomodulators for maintaining remission of patients with inflammatory bowel disease (IBD). However, there are few reports showing the real-world data of medication adherence to thiopurines for adult IBD patients, and the efficacy of patient education for medication adherence has not been clarified. We then conducted a single center prospective study to investigate whether nursing intervention can improve adherence to thiopurines in IBD patients.
Methods
IBD patients receiving constant doses of thiopurines for more than one year were enrolled from May 2016 to May 2017. After obtaining baseline questionnaire including 8-item Morisky Medication Adherence Scales (MMAS-8), a nurse provided each patient with the guidance about the importance of medication adherence by using the defined leaflet. The same questionnaires as baseline were obtained after 2 and 6 months. Primary endpoint was set at the alteration of MMAS-8 scores between the baseline and 6 months after the guidance.
Results
Among a total of 110 patients enrolled, 74 patients were analysed after excluding patients who discontinued thiopurines during the study period or answered the questionnaires incompletely. Anti-TNF agents were concomitantly used in 50 patients (67.6%), and 59 patients (79.7%) were in remission (CDAI of 150 or less for CD or pMayo of 2 or less for UC). Mean baseline MMAS-8 score was 6.54 out of 8, and the scores were significantly lower in female patients less than 40 years old, patients who feel poor disease condition, or those who fail to realise disease improvement. After 6 months of nursing intervention, mean MMAS-8 score was increased to 6.75, but not significant. However, in 22 patients with low baseline MMAS-8 scores of less than 6, MMAS-8 scores were significantly improved from 4.19 to 5.20 (p = 0.0005). Interestingly, the significant increase in mean corpuscular volume (MCV), a marker for the efficacy of thiopurines, was observed in both baseline MMAS-8 low and high (6–8) patients. Clinical activity indices were comparable after 6 months, possibly because a majority of outpatients in remission were included.
Conclusions
Nursing intervention is effective for improving adherence to thiopurines especially for patients whose baseline adherence are low. Also, MCV is increased even in patients whose baseline adherence are high, suggesting that all IBD patients receiving thiopurines can receive a significant benefit from nursing intervention.