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High refill-adherence to adalimumab is associated with low disease activity in patients with inflammatory bowel disease

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Abstract

Purpose

Adalimumab has evolved to one of the more affordable first-line biologics for the treatment of inflammatory bowel disease (IBD), since its patent expired. However, poor adherence to adalimumab is a concern and may limit its effectiveness. It is plausible that good adherence improves treatment outcomes in IBD patients, but evidence is scarce. The aim of this study was to assess whether high refill-adherence (medication possession ratio (MPR) ≥ 80%) to adalimumab is associated with less active disease in IBD patients.

Methods

In this retrospective study, the MPR was used to assess refill-adherence of IBD patients using adalimumab. Disease activity was defined as a composite endpoint determined by endoscopy findings, laboratory results, validated questionnaires and clinical assessment by a gastroenterologist. Logistic regression was used to determine the association between high refill-adherence (MPR ≥ 80%) and disease activity.

Results

IBD was in remission in 72 of the 113 included patients and 41 had active disease at the time of the most recent prescription. Out of the patients who were in remission, 86.1% were adherent vs. 75.6% in patients with active disease. High refill-adherence was significantly associated with lower odds of active disease after adjustment for confounders: adjusted odds ratio 0.297, 95% confidence interval 0.099–0.892.

Conclusion

High refill-adherence to adalimumab therapy was associated with less active disease in IBD patients. Our results confirm the relevance of good adherence to adalimumab for achieving optimal treatment results, which may limit the need for switching to more expensive biologics.

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Fig. 1

Data availability

The datasets generated during and/or analysed during the current study are not publicly available but are available from the corresponding author on reasonable request.

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Acknowledgements

We thank Lisette Binkhorst and Tanja Saat for their contribution to the early versions of the study protocol.

Author information

Author notes

  1. Rachel L. West and Erwin C. Vasbinder are joint senior authors.

Authors and Affiliations

  1. School of Pharmacy, Utrecht University, Utrecht, The Netherlands

    Esma H. San

  2. Department of Hospital Pharmacy, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam & Schiedam, The Netherlands

    Esma H. San, Angelique Egberts & Erwin C. Vasbinder

  3. Department of Outpatient Pharmacy, Franciscus Gasthuis & Vlietland, Rotterdam & Schiedam, The Netherlands

    Caroline W. Th. van Dijck - van Boetzelaer

  4. Department of Gastroenterology, Franciscus Gasthuis & Vlietland, Rotterdam & Schiedam, The Netherlands

    Rachel L. West

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Contributions

ES, AE, CvD, RW and EV: study concept and design. ES, AE, CvD and RW: acquisition of data. ES, AE, CvD, RW and EV: analysis and interpretation of data. AE and EV: supervision of the study. ES: drafting of the manuscript. AE, CvD, RW and EV: critical revision of the manuscript for important intellectual content. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Erwin C. Vasbinder.

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Ethics approval and consent to participate

The study protocol was approved by the hospital’s Scientific Advisory Board (study number 2017-012). According to Dutch legislation, neither obtaining informed consent nor approval by a medical ethics committee is obligatory for database studies without direct patient involvement.

Competing interests

The authors declare no competing interests.

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San, E.H., Egberts, A., van Dijck - van Boetzelaer, C.W.T. et al. High refill-adherence to adalimumab is associated with low disease activity in patients with inflammatory bowel disease. Eur J Clin Pharmacol (2024). https://doi.org/10.1007/s00228-024-03676-8

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  • DOI: https://doi.org/10.1007/s00228-024-03676-8

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