Digestive Diseases and Sciences

, Volume 56, Issue 12, pp 3463–3470 | Cite as

Twelve-Month Persistency with Oral 5-Aminosalicylic Acid Therapy for Ulcerative Colitis: Results from a Large Pharmacy Prescriptions Database

  • Sunanda V. Kane
  • Michael Sumner
  • Dory Solomon
  • Matthew Jenkins
Original Article



Patients receiving 5-aminosalicylic acid (5-ASA) require long-term therapy to achieve good outcomes. Persistency (duration of time from initiation to discontinuation of therapy) is therefore an important consideration.


To evaluate persistency in patients receiving various oral 5-ASA formulations.


This retrospective, 12-month, cohort study examined new-starter patients (any age and diagnosis) from a large United States pharmacy database who filled a prescription for oral 5-ASA [Lialda®, Asacol®, Pentasa® 250 or 500 mg, balsalazide (generic and Colazal®), and olsalazine (Dipentum®)] between March and September 2007. Persistency was evaluated monthly on the basis of prescription refill rates.


Prescription and refill records were identified for 44,191 patients receiving oral 5-ASA. After 1 year, 20% of patients receiving Lialda were considered persistent and classified as continuing (refilling within a timeframe of up to twice the duration of the prescription), compared with 9% receiving Asacol, 7 (250 mg) and 10% (500 mg) receiving Pentasa, 10% receiving balsalazide, and 10% receiving Dipentum.


Overall persistency with oral 5-ASA therapy was low. However, patients receiving once-daily Lialda had significantly higher persistency after 1 year of treatment than patients receiving other oral 5-ASA therapies.


5-aminosalicylic acid Mesalazine Mesalamine Persistency Ulcerative colitis Pharmacy database 



Initial data analyses were undertaken by Michael Cheyne and Matthew Hauben who are employees of SDI and received funding from Shire Pharmaceuticals Inc., USA. Writing and editorial support was provided by Duncan Campbell of GeoMed and funded by Shire Pharmaceuticals Inc., USA.

Conflict of interest

Sunanda Kane has served as a consultant for and has received research support from Shire Pharmaceuticals Inc., USA. Michael Sumner, Dory Solomon, and Matt Jenkins are all employees of Shire Pharmaceuticals Inc., USA.


  1. 1.
    Lichtenstein GR, Rutgeerts P. The importance of mucosal healing in ulcerative colitis. Inflamm Bowel Dis. 2009;16:338–346.Google Scholar
  2. 2.
    Rutgeerts P, Vermeire S, Van AG. Mucosal healing in inflammatory bowel disease: impossible ideal or therapeutic target? Gut. 2007;56:453–455.PubMedCrossRefGoogle Scholar
  3. 3.
    Carter MJ, Lobo AJ, Travis SP. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2004;53:V1–V16.PubMedCrossRefGoogle Scholar
  4. 4.
    Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults: American College Of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. 2010;105:501–523.PubMedCrossRefGoogle Scholar
  5. 5.
    Lichtenstein GR, Kamm MA. Review article: 5-aminosalicylate formulations for the treatment of ulcerative colitis–methods of comparing release rates and delivery of 5-aminosalicylate to the colonic mucosa. Aliment Pharmacol Ther. 2008;28:663–673.PubMedCrossRefGoogle Scholar
  6. 6.
    Cohen RD. Review article: evolutionary advances in the delivery of aminosalicylates for the treatment of ulcerative colitis. Aliment Pharmacol Ther. 2006;24:465–474.PubMedCrossRefGoogle Scholar
  7. 7.
    Qureshi AI, Cohen RD. Mesalamine delivery systems: do they really make much difference? Adv Drug Deliv Rev. 2005;57:281–302.PubMedCrossRefGoogle Scholar
  8. 8.
    Kane S, Huo D, Aikens J, Hanauer S. Medication nonadherence and the outcomes of patients with quiescent ulcerative colitis. Am J Med. 2003;114:39–43.PubMedCrossRefGoogle Scholar
  9. 9.
    Kane S, De Vos M, Riley S, Frieri G, Mittmann U. Compliance issues in inflammatory bowel disease. Rev Gastroenterol Disord. 2005;5:101–106.Google Scholar
  10. 10.
    Kane S, Shaya F. Medication non-adherence is associated with increased medical health care costs. Dig Dis Sci. 2008;53:1020–1024.PubMedCrossRefGoogle Scholar
  11. 11.
    Sewitch MJ, Abrahamowicz M, Barkun A, et al. Patient nonadherence to medication in inflammatory bowel disease. Am J Gastroenterol. 2003;98:1535–1544.PubMedCrossRefGoogle Scholar
  12. 12.
    Shale MJ, Riley SA. Studies of compliance with delayed-release mesalazine therapy in patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2003;18:191–198.PubMedCrossRefGoogle Scholar
  13. 13.
    van Hees PA, van Tongeren JH. Compliance to therapy in patients on a maintenance dose of sulfasalazine. J Clin Gastroenterol. 1982;4:333–336.PubMedCrossRefGoogle Scholar
  14. 14.
    Bernal I, Domenech E, Garcia-Planella E, et al. Medication-taking behavior in a cohort of patients with inflammatory bowel disease. Dig Dis Sci. 2006;51:2165–2169.PubMedCrossRefGoogle Scholar
  15. 15.
    Cerveny P, Bortlik M, Kubena A, Vlcek J, Lakatos PL, Lukas M. Nonadherence in inflammatory bowel disease: results of factor analysis. Inflamm Bowel Dis. 2007;13:1244–1249.PubMedCrossRefGoogle Scholar
  16. 16.
    Kane SV, Cohen RD, Aikens JE, Hanauer SB. Prevalence of nonadherence with maintenance mesalamine in quiescent ulcerative colitis. Am J Gastroenterol. 2001;96:2929–2933.PubMedCrossRefGoogle Scholar
  17. 17.
    Kane SV. Strategies to improve adherence and outcomes in patients with ulcerative colitis. Drugs. 2008;68:2601–2609.PubMedCrossRefGoogle Scholar
  18. 18.
    Stone MA, Mayberry JF, Baker R. Prevalence and management of inflammatory bowel disease: a cross-sectional study from central England. Eur J Gastroenterol Hepatol. 2003;15:1275–1280.PubMedCrossRefGoogle Scholar
  19. 19.
    Kane SV, Brixner D, Rubin DT, Sewitch MJ. The challenge of compliance and persistence: focus on ulcerative colitis. J Manag Care Pharm. 2008;14:s2–s12.PubMedGoogle Scholar
  20. 20.
    Burnier M. Medication adherence and persistence as the cornerstone of effective antihypertensive therapy. Am J Hypertens. 2006;19:1190–1196.PubMedCrossRefGoogle Scholar
  21. 21.
    Cramer JA, Silverman S. Persistence with bisphosphonate treatment for osteoporosis: finding the root of the problem. Am J Med. 2006;119:S12–S17.PubMedCrossRefGoogle Scholar
  22. 22.
    Cramer JA, Benedict A, Muszbek N, Keskinaslan A, Khan ZM. The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review. Int J Clin Pract. 2008;62:76–87.PubMedCrossRefGoogle Scholar
  23. 23.
    Breekveldt-Postma NS, Koerselman J, Erkens JA, Lammers JW, Herings RM. Enhanced persistence with tiotropium compared with other respiratory drugs in COPD. Respir Med. 2007;101:1398–1405.PubMedCrossRefGoogle Scholar
  24. 24.
    Esposito D, Wahl P, Daniel G, Stoto MA, Erder MH, Croghan TW. Results of a retrospective claims database analysis of differences in antidepressant treatment persistence associated with escitalopram and other selective serotonin reuptake inhibitors in the United States. Clin Ther. 2009;31:644–656.PubMedCrossRefGoogle Scholar
  25. 25.
    Hassan M, Madhavan SS, Kalsekar ID, et al. Comparing adherence to and persistence with antipsychotic therapy among patients with bipolar disorder. Ann Pharmacother. 2007;41:1812–1818.PubMedCrossRefGoogle Scholar
  26. 26.
    Lee PP, Walt JG, Chiang TH, Guckian A, Keener J. A gap analysis approach to assess patient persistence with glaucoma medication. Am J Ophthalmol. 2007;144:520–524.PubMedCrossRefGoogle Scholar
  27. 27.
    Loftus EV Jr. A practical perspective on ulcerative colitis: patients’ needs from aminosalicylate therapies. Inflamm Bowel Dis. 2006;12:1107–1113.PubMedCrossRefGoogle Scholar
  28. 28.
    Rubin DT, Siegel CA, Kane SV, et al. The impact of ulcerative colitis from patients’ and physicians’ perspectives: results from the UC: NORMAL survey. Inflamm Bowel Dis. 2009;15:581–588.PubMedCrossRefGoogle Scholar
  29. 29.
    Ediger JP, Walker JR, Graff L, et al. Predictors of medication adherence in inflammatory bowel disease. Am J Gastroenterol. 2007;102:1–10.CrossRefGoogle Scholar
  30. 30.
    Magowan SKS, Lange J. 5-ASA prescription refill rates of ulcerative colitis are independent of formulation and dosing regimens. Am J Gastroenterol. 2006;101:S447. (Abstract 1144).Google Scholar
  31. 31.
    Gray JR, Leung E, Scales J. Treatment of ulcerative colitis from the patient’s perspective: a survey of preferences and satisfaction with therapy. Aliment Pharmacol Ther. 2009;29:1114–1120.PubMedCrossRefGoogle Scholar
  32. 32.
    Kane SV, Accortt NA, Magowan S, Brixner D. Predictors of persistence with 5-aminosalicylic acid therapy for ulcerative colitis. Aliment Pharmacol Ther. 2009;29:855–862.PubMedCrossRefGoogle Scholar
  33. 33.
    Collinson S. Payment for treatment adherence: incentives help vulnerable patients to stay well. BMJ. 2007;335:317.PubMedCrossRefGoogle Scholar
  34. 34.
    Kripalani S, Yao X, Haynes RB. Interventions to enhance medication adherence in chronic medical conditions: a systematic review. Arch Intern Med. 2007;167:540–550.PubMedCrossRefGoogle Scholar
  35. 35.
    Herrinton LJ, Liu L, Fireman B, et al. Time trends in therapies and outcomes for adult inflammatory bowel disease, Northern California, 1998–2005. Gastroenterology. 2009;137:502–511.PubMedCrossRefGoogle Scholar
  36. 36.
    Levy RL, Feld AD. Increasing patient adherence to gastroenterology treatment and prevention regimens. Am J Gastroenterol. 1999;94:1733–1742.PubMedCrossRefGoogle Scholar
  37. 37.
    Nguyen GC, Laveist TA, Harris ML, Datta LW, Bayless TM, Brant SR. Patient trust-in-physician and race are predictors of adherence to medical management in inflammatory bowel disease. Inflamm Bowel Dis. 2009;15:1233–1239.PubMedCrossRefGoogle Scholar
  38. 38.
    DiMatteo MR, Sherbourne CD, Hays RD, et al. Physicians’ characteristics influence patients’ adherence to medical treatment: results from the Medical Outcomes Study. Health Psychol. 1993;12:93–102.PubMedCrossRefGoogle Scholar
  39. 39.
    D’Inca R, Bertomoro P, Mazzocco K, Vettorato MG, Rumiati R, Sturniolo GC. Risk factors for non-adherence to medication in inflammatory bowel disease patients. Aliment Pharmacol Ther. 2008;27:166–172.PubMedCrossRefGoogle Scholar
  40. 40.
    Kane SV. Systematic review: adherence issues in the treatment of ulcerative colitis. Aliment Pharmacol Ther. 2006;23:577–585.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Sunanda V. Kane
    • 1
  • Michael Sumner
    • 2
  • Dory Solomon
    • 2
  • Matthew Jenkins
    • 2
  1. 1.Division of Gastroenterology and HepatologyMayo Clinic College of MedicineRochesterUSA
  2. 2.Shire Pharmaceuticals Inc.WayneUSA

Personalised recommendations