1. Low Adherence is Associated with Chronic Active Disease in Ulcerative Colitis: A Retrospective Study from a Single Referral Center
- Author
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Viola A, Demarzo MG, Abbruzzese A, Muscianisi M, Chiappetta MF, Costantino G, Ksissa O, Alibrandi A, and Fries W
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outcome ,adherence ,surgery ,hospitalization ,disease course ,Medicine (General) ,R5-920 - Abstract
Anna Viola,1 Maria Giulia Demarzo,1,2 Alfredo Abbruzzese,1,3 Marco Muscianisi,1 Michele Francesco Chiappetta,1,3 Giuseppe Costantino,1 Omar Ksissa,1,3 Angela Alibrandi,4 Walter Fries1 1Department of Clinical and Experimental Medicine, IBD-Unit, University of Messina, Messina, Italy; 2Department of Internal Medicine, Ospedale Policlinico San Martino-IRCCS per l’Oncologia, Gastroenterology Unit, University of Genoa, Genoa, Italy; 3Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Italy; 4Department of Economics; Unit of Statistical and Mathematical Sciences, University of Messina, Messina, ItalyCorrespondence: Anna Viola, Clinical Unit of Gastroenterology and Chronic Bowel Disorders, Department of Clinical and Experimental Medicine, Via Consolare Valeria 1, Messina, 9815, Italy, Tel +39 3338377928, Email aviola@unime.itPurpose: New therapeutic approaches for ulcerative colitis (UC) are now available, but there is still no robust evidence for predictors of poor outcomes. We aimed to evaluate the factors associated with a chronic active UC disease course.Patients and Methods: Data of all UC outpatients followed for at least 3 years after diagnosis between 2005 and 2018 were retrospectively collected. The primary aim was to identify risk factors for chronic active disease 3 years after diagnosis. Moreover, the following variables were investigated: proximal disease extension or disease regression, proctocolectomy, early use of biologics (BIO) or immunomodulators (IMM), hospitalization, colorectal cancer, and adherence. We defined adherence as both, taking the prescribed therapy and constancy in scheduled follow-up visits.Results: A total of 345 UC patients followed for a median period of 82 months were included. Patients with extensive colitis at diagnosis had a higher rate of chronic active disease 3 years after diagnosis (p< 0.012) together with a higher rate of surgery (p< 0.001) at maximum follow-up. Patients with pancolitis showed significant disease regression over time (51%) without differences in treatment. The only factor associated with chronic active disease was non-adherence (p < 0.03; OR 0.49, 95% CI: 0.26– 0.95). Adherent patients developed chronic active disease (p< 0.025) less frequently but did receive more frequent IMM (p< 0.045) or BIO (p< 0.009) therapy.Conclusion: Patients diagnosed with pancolitis were more likely to have chronic active disease and to undergo colectomy. The only predictor for developing chronically active UC regardless of disease extension was the lack of adherence to therapy within the first 3 years after diagnosis, underlining the importance of tight control of UC patients and the need to timely identify potential risk factors for non-adherence.Keywords: outcome, adherence, surgery, hospitalization, disease course
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- 2023