OBJECTIVES: Biologic therapies have become mainstays of treatment for inflammatory bowel disease (IBD), with numerous treatment options now approved in the United States (US). However, evidence of adherence with biologic therapies in IBD is limited. This study sought to systematically review the literature on real-world adherence with biologics in IBD (Crohn’s disease [CD] and ulcerative colitis [UC]) among adult patients in the US.
METHODS: A systematic search and review of electronic medical databases (PubMed, Embase, and Cochrane; 2012 forward), conference abstracts (2016-2017), and bibliographies.
RESULTS: Nine relevant retrospective studies reporting data on adherence were identified (3 in CD and 6 in IBD populations). Five studies reported percentage of adherent patients using a medication possession ratio (MPR) threshold of ≥80% (n=4) or ≥86% (n=1). Adherence in these studies ranged from 38%-77% (proportion nonadherent patients: 23%-62%). Three studies reported the average MPR of a patient cohort, with a range of 83.7%-97.4%. One study reported adherence as proportion of patients who did not experience a medication interruption due to patient-driven circumstances (87%). Worse adherence was linked to female sex and presence of depressive symptoms. There was insufficient evidence to make claims about the influence of concurrent medications, disease extent or behavior, or age on the rates of biologics adherence in IBD patients. Two studies assessed costs associated with nonadherence to biologics in IBD and found that nonadherence had significant cost implications (total costs, hospitalizations, and new steroid use).
CONCLUSIONS: Findings of this systematic literature review highlight high rates of nonadherence with biologics among IBD patients.
