Medication nonadherence may lead to treatment escalation in children with UC

In paediatric patients with ulcerative colitis (UC), nonadherence to mesalazine negatively affects its therapeutic efficacy and may, in turn, result in treatment escalation, according to data from PROTECT.

PROTECT included 268 newly diagnosed paediatric UC patients (mean age, 12.3 years; 50 percent female). All patients received standardized mesalazine, with pre‐established criteria for escalation to thiopurines or anti‐tumour necrosis factor alpha (TNFα inhibitors). Adherence was monitored using pill bottles with electronic caps.

Researchers examined whether longitudinal adherence to treatment was associated with steroid‐free remission at week 52 (defined as quiescent disease on mesalazine alone with no corticosteroids ≥4 weeks prior) and need for treatment escalation (defined as introduction of immunomodulators, calcineurin‐inhibitors or anti‐TNFα inhibitors).

Results revealed that average mesalazine adherence trajectories were not predictive of steroid‐free remission at week 52. On the other hand, declining adherence over time (adherence rate of ≤85.7 percent at month 6) showed a strong association with treatment escalation (p=0.001).

According to the researchers, the present data highlight the importance of targeting adherence difficulties early in the disease course to reduce the likelihood of the need for treatment escalation in this population. They also stressed that treatment escalation is not based on suboptimal adherence to maintenance medication, but rather on disease response (or lack of response) to maintenance medication.