Study of the Week: Young People with Ulcerative Colitis Have Low Treatment Adherence

Welcome to Study of the Week from Patient Worthy. In this segment, we select a study we posted about from the previous week that we think is of particular interest or importance and go more in-depth. In this story we will talk about the details of the study and explain why it’s important, who will be impacted, and more.

If you read our short form research stories and find yourself wanting to learn more, you’ve come to the right place.


This week’s study is…

Adherence to 5-aminosalicylic acid maintenance treatment in young people with ulcerative colitis: a retrospective cohort study in primary care

We previously published about this research in a story titled “Medication Adherence Low in Young Adults with Ulcerative Colitis (UC), Study Says” which can be found here. The study was originally published in the scientific journal British Journal of General Practice. You can read the full text of the study here

This research team was associated with the St. George’s University Hospitals NHS Foundation Trust.

What Happened?

Ulcerative colitis is a rare form of inflammatory bowel disease. A common therapy used for maintenance of remission is 5-aminosalicylic acid (5-ASA). However, little is known about how well patients adhere to treatment with this medication in their first year of use. The goal of this study was to evaluate treatment adherence in younger people living with ulcerative colitis that were beginning maintenance therapy with 5-ASA.

Rates of ulcerative colitis appear to be increasing, particularly in younger age groups. The research team looked at data from 607 patients between ages 10-24. These patients were diagnosed between 1998 and 2016. Fifty-six percent of the patients were males and 70% were between age 18-24. These patients were beginning maintenance therapy with 5-ASA, which is widely considered to be the first-line maintenance treatment in ulcerative colitis.

The scientists monitored each patient from the onset of treatment for a duration of one year, or until death or de-registration. What they found was that a high percentage of patients (69%) discontinued maintenance therapy with 5-ASA within the year. Twenty-five percent of this group halted treatment after just 34 days. The median time of treatment discontinuation was 162 days. Young adults in the 18-24 age range were most likely to quit, with 74% choosing to do so; the discontinuation rate was lower in the younger groups, with 61% of 10–14-year-olds and 56% of 15–17-year-olds stopping treatment.

The researchers identified some risk factors for 5-ASA therapy discontinuation, such as old age at initiation of therapy and living in low-income areas. Patients that suffered a symptom flareup that required corticosteroid use early in the disease course were more likely to adhere to treatment. Overall, the study authors concluded that young adults were at a high risk of discontinuing maintenance therapy with 5-ASA and emphasized the need for physicians to follow-up with these patients in their first year of treatment.

About Ulcerative Colitis

Ulcerative colitis is a long-term condition which is characterized by the appearance of ulcers and generalized inflammation of the rectum and colon. The exact cause of the condition remains a mystery, but there do appear to be some risk factors, such as family history, diet, and exposure to the medication isotrentinoin. Smoking appears to have a slightly protective effect. Symptoms can include anemia, bloody diarrhea, weight loss, fever, and abdominal pain. They tend to appear in a relapsing-remitting pattern. In severe disease there is a risk of serious complications, such as megacolon or inflammatory disease in other parts of the body. The risk of colon cancer is also elevated. Treatment may include dietary changes, medication to control inflammation, and, when complications appear, surgery. To learn more about ulcerative colitis, click here.

Why Does it Matter?

An important component of the success of treatment in any condition is consistency and adherence to dosing recommendations on the part of the patient. While at first glance it may seem unusual that a patient might struggle to follow treatment recommendations, some of the risk factors found in the study may potentially shed light on the issue.

Side effects are a major reason why patients may struggle to follow a therapy regimen. In some instances, patients may find that side effects from a drug are just as difficult as the disease symptoms. This study found that patients from low-income areas were more likely to discontinue therapy. This might suggest that treatment cost was a significant factor in patients deciding to discontinue. 

Future research directions might include investigating the reasons behind therapy discontinuation more thoroughly.


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