Patient's adherence to medications and quality of life in inflammatory bowel diseases

Introduction: One of the most important goals of any treatment for inflammatory bowel disease (IBD) is the overall improvement of the patients' quality of life (QOL), because both Crohn's disease (CD) and ulcerative colitis (UC) are chronic diseases, mostly necessitating lifelong drug treatment in order to maintain remission. The poor adherence of patients to the long-lasting medical therapy is one of the most important factors of the treatment failure.

Aims: The aim of our study was to assess the medication adherence in connection with the QOL in our patients with IBD in order to identify how the patients' condition affects the attitude to maintenance therapy.

Patients and methods: Health-related QOL and medication adherence were measured by questionnaires posted to 150 IBD patients treated at our department. After the assessment of the questionnaires, patients were classified into three groups on the basis of their answers related to the QOL. Relationships between different predictors and the QOL and the medication adherence were statistically analyzed in every group. P values<0.05 were considered statistically significant.

Results: 69 IBD patients (23 CD, 46 UC) completed the questionnaires. There was no significant difference between the QOL of CD and UC patients. 23% of the IBD patients were classified into the good, 45% into moderate and 32% into bad groups of QOL. 5-ASA compounds were the most frequently unused therapeutic agents. Forgetfulness was the most common comment of the non-adherence. Disease activity, reduced work productivity, low income and disability were the strongest predictors of QOL impairment. The significantly highest proportion (31%) of non-adherence was observed in the IBD patients being in remission.

Summary: IBD contributed to moderate or bad QOL in 77% of our patients. Patients in remission had the highest risk for becoming non-adherent to their prescribed treatment regimen. Improving QOL should be very important in the care of IBD patient; however, without increasing the compliance, there is no chance to modify the long-lasting outcome of IBD.