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Sariahmed K, Kurian J, Singh AK, Leyton C, Minuti A, Jerschow E, Arora S, Jariwala SP. Social, political, and economic determinants of access to biologics: A scoping review of structural determinants in the clinical disparities literature. Res Social Adm Pharm 2022; 18:4038-4047. [DOI: 10.1016/j.sapharm.2022.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/05/2022] [Accepted: 07/28/2022] [Indexed: 02/07/2023]
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Shah NB, Haydek J, Slaughter J, Ashton JR, Zuckerman AD, Wong R, Raffa F, Garrett A, Duley C, Annis K, Wagnon J, Gaines L, Dalal R, Scoville E, Beaulieu DB, Schwartz D, Horst SN. Risk Factors for Medication Nonadherence to Self-Injectable Biologic Therapy in Adult Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2020; 26:314-320. [PMID: 31671188 PMCID: PMC7534378 DOI: 10.1093/ibd/izz253] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND In inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), nonadherence to biologic therapy increases risk of disease flare. The aim of this study was to identify risk factors for nonadherence. METHODS This was a single-center retrospective study evaluating patients with IBD treated at a tertiary care center and prescribed self-injectable biologic therapy using the center's specialty pharmacy. Adherence was defined using medication possession ratio (MPR). Nonadherence was defined as MPR <0.86. RESULTS Four hundred sixty patients (n = 393 with CD and n = 67 with UC) were evaluated with mean MPR (interquartile range) equaling 0.89 (0.48-1). Overall, 69% of patients were adherent (defined as MPR ≥0.86), 66% of patients with CD and 87% of patients with UC. In univariate analysis, several factors increased risk of nonadherence: CD diagnosis, insurance type, psychiatric history, smoking, prior biologic use, and narcotic use (P < 0.05). In multivariable analysis, Medicaid insurance (odds ratio [OR], 5.5; 95% confidence interval [CI], 1.85-15.6) and CD diagnosis (OR, 2.8; 95% CI, 1.3-6.0) increased risk of nonadherence. In CD, as the number of risk factors increased (narcotic use, psychiatric history, prior biologic use, and smoking), the probability of nonadherence increased. Adherence was 72% in patients with 0-1 risk factors, decreasing to 62%, 61%, and 42% in patients with 2, 3, and 4 risk factors, respectively (P < 0.05). CONCLUSIONS This study identified risk factors for nonadherence to biologic therapy. In patients with CD, the probability of nonadherence increased as the number of risk factors increased.
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Affiliation(s)
- Nisha B Shah
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer Haydek
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Slaughter
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Rochelle Wong
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Francesca Raffa
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ailish Garrett
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Caroline Duley
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kim Annis
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Julianne Wagnon
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lawrence Gaines
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robin Dalal
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Dawn B Beaulieu
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David Schwartz
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sara N Horst
- Vanderbilt University Medical Center, Nashville, Tennessee, USA,Address correspondence to: Sara N. Horst, MD MPH, Vanderbilt University Medical Center, 1211 21st Ave. South, Suite 220, Nashville, TN 37232 ()
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