Impact and risk factors of non-adherence to 5-aminosalicylates in quiescent ulcerative colitis evaluated by an electronic management system

  • M. P. Ballester
  • D. Marti-AguadoEmail author
  • M. Fullana
  • M. M. Bosca-Watts
  • J. Tosca
  • E. Romero
  • A. Sanchez
  • P. Navarro-Cortes
  • R. Anton
  • F. Mora
  • M. Minguez
Original Article


Background and objective

To determine the impact of non-adherence to 5-Aminosalicylates (5-ASA) on the risk of flares and to identify risk factors of non-adherence.


Observational, cohort study of ulcerative colitis (UC) patients in clinical remission at least 6 months on 5-ASA monotherapy maintenance prescribed by an electronic management program. Adherence was considered when 80% of the prescribed 5-ASA had been dispensed at the pharmacy. The study analyzed the existence and degree of 5-ASA adherence, disease course, UC phenotypic expression, and 5-ASA dose and regimen, and consumption of non-UC chronic drugs during 2-year follow-up.


The study included 274 patients, 49% males with a median age of 38 (27–49) years old. Overall, 41% of patients were non-adherent to 5-ASA. Risk of flares was reduced in the adherent group (36% vs 54%; OR = 0,484; p = 0,004), mainly the mild ones (26% vs 38%; OR = 0,559; p = 0,031). Non-adherence was associated with younger age at diagnosis (32 (26–45) vs 41.5 (21–50), p = 0.000) and no-consumption of other chronic treatments (1.1 vs 2.1; OR = 1709; p = 0,048).


Non-adherence to 5-ASA evaluated by the pharmaceutical management system was at 41% with a higher risk of relapse. Younger patients and patients who do not receive non-UC chronic treatments showed lower adherence rate.


Colitis, ulcerative Aminosalicylic acids Treatment adherence and compliance Treatment outcome Symptom flare-up 


Authors’ contributions

Conception and design of the study: Ballester MP, Martí-Aguado D, Fullana M, Bosca-Watts MM, and Minguez M

Acquisition of data: Ballester MP, Martí-Aguado D, Fullana M, Romero E, Sanchez A, Navarro P, and Anton R

Analysis and interpretation of data: Ballester MP, Martí-Aguado D, Bosca-Watts MM, Tosca J, and Minguez M

Manuscript writing: Ballester MP, Martí-Aguado D, Bosca-Watts MM, Tosca J, Mora F, and Minguez M

All listed authors approved the final version.

Compliance with ethical standards

Conflict of interest

M. Minguez has served as a speaker, a consultant, and advisory member for or has received research funding from MSD, Abbvie, Pfizer, Janssen, Shire Pharmaceuticals, Allergan.

M.M. Bosca-Watts declares educational activities, research projects, scientific meetings, and advisory boards sponsored by MSD, Ferring, Abbvie, Janssen, and Takeda.

Informed consent statement

All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Institutional review board approval

The study was reviewed and approved by the University Clinic Hospital of Valencia, Institutional Review Board.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • M. P. Ballester
    • 1
  • D. Marti-Aguado
    • 1
    Email author
  • M. Fullana
    • 2
  • M. M. Bosca-Watts
    • 1
  • J. Tosca
    • 1
  • E. Romero
    • 1
  • A. Sanchez
    • 1
  • P. Navarro-Cortes
    • 1
  • R. Anton
    • 1
  • F. Mora
    • 1
    • 2
  • M. Minguez
    • 1
    • 2
  1. 1.IBD Unit, Digestive Disease Department, University Clinic Hospital of ValenciaUniversity of ValenciaValenciaSpain
  2. 2.University of ValenciaValenciaSpain

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