Pregnant women with IBD are more likely to be adherent to biologic therapies than other medications.
Adult
Biological Factors
/ therapeutic use
Biological Therapy
/ methods
Canada
/ epidemiology
Drug Prescriptions
/ statistics & numerical data
Female
Humans
Inflammatory Bowel Diseases
/ drug therapy
Medication Adherence
/ statistics & numerical data
Mesalamine
/ therapeutic use
Pregnancy
Pregnancy Complications
/ drug therapy
Pregnancy Outcome
/ epidemiology
Young Adult
Journal
Alimentary pharmacology & therapeutics
ISSN: 1365-2036
Titre abrégé: Aliment Pharmacol Ther
Pays: England
ID NLM: 8707234
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
24
05
2019
revised:
28
06
2019
accepted:
06
11
2019
pubmed:
5
12
2019
medline:
29
8
2020
entrez:
5
12
2019
Statut:
ppublish
Résumé
There are differences in the efficacy and safety profiles of medications used to treat IBD that may impact a woman's perceived risk of medication exposure during pregnancy, potentially leading to medication non-adherence, poor disease-control and adverse pregnancy outcomes. To assess whether medication adherence patterns differ by drug class during pregnancy and influence birth outcomes for women with IBD. Of 143 491 women, a validated case definition was used to identify 370 women with IBD in five administrative health databases in Alberta, Canada (2012-2015). Women who had ≥2 consecutive medications prescription for maintenance therapy for IBD in the year prior to pregnancy were included (n = 230). Prescription-based medication possession ratio ≥0.8 defined adherence. Chi-squared tests were used to compare adherence patterns by drug class and outcomes. Of the 159/230 women who were adherent during the year prior to pregnancy, 20 (12.6%; 95% CI: 8.2%, 18.8%) were not adherent and 21 (13.2%; 95% CI: 8.7%, 19.5%) discontinued their medications during pregnancy. Medication adherence during pregnancy differed significantly by drug class. A greater proportion of women on biologics (41.5%; 95% CI 32.9%, 50.7%) were adherent during pregnancy than women on thiopurines (22.9%; 95% CI 16.1%, 31.5%; P = 0.006); adherence was not significantly different for 5-aminosalicylates (35.6%; 95% CI 27.4%, 44.8%; P = 0.204). Women were more likely to be adherent to biologics (49.3%, 95% CI 37.3%, 61.3%) than thiopurines (20.9%; 95% CI 12.6%, 32.6%; P = 0.014) and 5-aminosalicylates (29.9%; 95% CI 19.9%, 42.1%; P = 0.030) in the first trimester. This was similar in the third trimester. In the second trimester, adherence pattern did not significantly differ by drug class (biologics vs thiopurines: P = 0.348; biologics vs 5-aminosalicylate: P = 0.999). Infants born to women with IBD (adherent: RR 1.58. 95% CI 1.02, 2.27; non-adherent: RR 1.32, 95% CI 0.97, 1.81) were more likely to be admitted into the neonatal intensive care unit than the general obstetric population, but this was not significantly different between women who were adherent or not adherent to their IBD medication (P = 0.711). Almost a quarter of women with IBD who were previously adherent to medical therapy were not adherent during pregnancy. Adherence pattern differed by drug class.
Sections du résumé
BACKGROUND
There are differences in the efficacy and safety profiles of medications used to treat IBD that may impact a woman's perceived risk of medication exposure during pregnancy, potentially leading to medication non-adherence, poor disease-control and adverse pregnancy outcomes.
AIM
To assess whether medication adherence patterns differ by drug class during pregnancy and influence birth outcomes for women with IBD.
METHODS
Of 143 491 women, a validated case definition was used to identify 370 women with IBD in five administrative health databases in Alberta, Canada (2012-2015). Women who had ≥2 consecutive medications prescription for maintenance therapy for IBD in the year prior to pregnancy were included (n = 230). Prescription-based medication possession ratio ≥0.8 defined adherence. Chi-squared tests were used to compare adherence patterns by drug class and outcomes.
RESULTS
Of the 159/230 women who were adherent during the year prior to pregnancy, 20 (12.6%; 95% CI: 8.2%, 18.8%) were not adherent and 21 (13.2%; 95% CI: 8.7%, 19.5%) discontinued their medications during pregnancy. Medication adherence during pregnancy differed significantly by drug class. A greater proportion of women on biologics (41.5%; 95% CI 32.9%, 50.7%) were adherent during pregnancy than women on thiopurines (22.9%; 95% CI 16.1%, 31.5%; P = 0.006); adherence was not significantly different for 5-aminosalicylates (35.6%; 95% CI 27.4%, 44.8%; P = 0.204). Women were more likely to be adherent to biologics (49.3%, 95% CI 37.3%, 61.3%) than thiopurines (20.9%; 95% CI 12.6%, 32.6%; P = 0.014) and 5-aminosalicylates (29.9%; 95% CI 19.9%, 42.1%; P = 0.030) in the first trimester. This was similar in the third trimester. In the second trimester, adherence pattern did not significantly differ by drug class (biologics vs thiopurines: P = 0.348; biologics vs 5-aminosalicylate: P = 0.999). Infants born to women with IBD (adherent: RR 1.58. 95% CI 1.02, 2.27; non-adherent: RR 1.32, 95% CI 0.97, 1.81) were more likely to be admitted into the neonatal intensive care unit than the general obstetric population, but this was not significantly different between women who were adherent or not adherent to their IBD medication (P = 0.711).
CONCLUSION
Almost a quarter of women with IBD who were previously adherent to medical therapy were not adherent during pregnancy. Adherence pattern differed by drug class.
Substances chimiques
Biological Factors
0
Mesalamine
4Q81I59GXC
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
544-552Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2019 John Wiley & Sons Ltd.
Références
Kaplan GG, Bernstein CN, Coward S, et al. The impact of inflammatory bowel disease in Canada 2018: epidemiology. J Can Assoc Gastroenterol. 2018;2(Suppl._1):S6-S16.
Lenti MV, Selinger CP. Medication non-adherence in adult patients affected by inflammatory bowel disease: a critical review and update of the determining factors, consequences and possible interventions. Expert Rev Gastroenterol Hepatol. 2017;11:1-12.
Colombel J-F, Panaccione R, Bossuyt P, et al. Effect of tight control management on Crohn’s disease (CALM): a multicentre, randomised, controlled phase 3 trial. Lancet (London, England). 2018;390:2779-2789.
Khanna R, Bressler B, Levesque BG, et al. Early combined immunosuppression for the management of Crohn’s disease (REACT): a cluster randomised controlled trial. Lancet (London, England). 2015;386:1825-1834.
Colombel J-F, Sands BE, Rutgeerts P, et al. The safety of vedolizumab for ulcerative colitis and Crohn’s disease. Gut. 2017;66:839-851.
Nguyen GC, Seow CH, Maxwell C, et al. The Toronto Consensus Statements for the management of inflammatory bowel disease in pregnancy. Gastroenterology. 2016;150:734-757.
Benchimol EI, Manuel DG, Guttmann A, et al. Changing age demographics of inflammatory bowel disease in Ontario, Canada: a population-based cohort study of epidemiology trends. Inflamm Bowel Dis. 2014;20:1761-1769.
Carter MJ, Lobo AJ, Travis SPL. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2004;53(Suppl. 5):V1-16.
Ujihara M, Ando T, Ishiguro K, et al. Importance of appropriate pharmaceutical management in pregnant women with ulcerative colitis. BMC Res Notes. 2013;25:210.
Bröms G, Granath F, Linder M, Stephansson O, Elmberg M, Kieler H. Birth outcomes in women with inflammatory bowel disease: effects of disease activity and drug exposure. Inflamm Bowel Dis. 2014;20:1091-1098.
Martinez Lopez JA, Loza E, Carmona L, Martínez Lopez JA, Loza E, Carmona L. Systematic review on the safety of methotrexate in rheumatoid arthritis regarding the reproductive system (fertility, pregnancy, and breastfeeding). Clin Exp Rheumatol. 2009;27:678-684.
Sachdeva P, Patel B, Patel B. Drug use in pregnancy; a point to ponder!. Indian J Pharm Sci. 2009;71:7.
Matsui D. Adherence with drug therapy in pregnancy. Obs Gynecol Int. 2012;2012:796590.
Mountifield RE, Prosser R, Bampton P, Muller K, Andrews JM. Pregnancy and IBD treatment: This challenging interplay from a patients’ perspective. J Crohn’s Colitis. 2010;4:176-182.
Selinger CP, Eaden J, Selby W, et al. Inflammatory bowel disease and pregnancy: lack of knowledge is associated with negative views. J Crohns Colitis. 2013;7:e206-e213.
Benchimol EI, Smeeth L, Guttmann A, et al. The reporting of studies conducted using observational routinely-collected health data (RECORD) statement. PLoS Medicine Med. 2015;12:e1001885.
Rezaie A, Quan H, Fedorak RN, Panaccione R, Hilsden RJ. Development and validation of an administrative case definition for inflammatory bowel diseases. Can J Gastroenterol. 2012;26:711-717.
Norweigian Institute of Public Health. ATC/DDD Index 2018 [Internet]. WHO Collaborating Centre for Drug Statistics Methodology. 2017. https://www.whocc.no/atc_ddd_index/
Tang KL, Quan H, Rabi DM. Measuring medication adherence in patients with incident hypertension: a retrospective cohort study. BMC Health Serv Res. 2017;17:1-16.
Chan W, Chen A, Tiao D, Selinger C, Leong R. Medication adherence in inflammatory bowel disease. Intest Res. 2017;15:434.
VanderWeele TJ, Ding P. Sensitivity analysis in observational research: Introducing the E-value. Ann Intern Med. 2017;167:268-274.
Haneuse S, VanderWeele TJ, Arterburn D. Using the E-Value to assess the potential effect of unmeasured confounding in observational studies. JAMA. 2019;321:602-603.
Julsgaard M, Nrgaard M, Hvas CL, Buck D, Christensen LA. Self-reported adherence to medical treatment prior to and during pregnancy among women with ulcerative colitis. Inflamm Bowel Dis. 2011;17:1573-1580.
Gallinger ZR, Rumman A, Nguyen GC. Perceptions and attitudes towards medication adherence during pregnancy in inflammatory bowel disease. J Crohns Colitis. 2016;10:892-897.
Tsao NW, Lynd LD, Sadatsafavi M, Hanley G, De Vera MA. Patterns of biologics utilization and discontinuation before and during pregnancy in women with autoimmune diseases: a population-based cohort study. Arthritis Care Res. 2018;70:979-986.
Buicko JL, Parreco J, Abel SN, Lopez MA, Sola JE, Perez EA. Pediatric laparoscopic appendectomy, risk factors, and costs associated with nationwide readmissions. J Surg Res. 2017;215:245-249.
Sewitch MJ, Abrahamowicz M, Barkun A, et al. Patient nonadherence to medication in inflammatory bowel disease. Am J Gastroenterol. 2003;98:1535-1544.
Oron G, Yogev Y, Shkolnik S, et al. Inflammatory bowel disease: risk factors for adverse pregnancy outcome and the impact of maternal weight gain. J Matern Neonatal Med. 2012;25:2256-2260.
O’Toole A, Nwanne O, Tomlinson T. Inflammatory bowel disease increases risk of adverse pregnancy outcomes: a meta-analysis. Dig Dis Sci. 2015;60:2750-2761.
Nielsen OH, Loftus EV, Jess T. Safety of TNF-α inhibitors during IBD pregnancy: a systematic review. BMC Med. 2013;11:174.
Norgard B, Fonager K, Pedersen L, Jacobsen BA, Sorensen HT. Birth outcome in women exposed to 5-aminosalicylic acid during pregnancy: a Danish cohort study. Gut. 2003;52:243-247.
Akbari M, Shah S, Velayos FS, Mahadevan U, Cheifetz AS. Systematic review and meta-analysis on the effects of thiopurines on birth outcomes from female and male patients with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19:15-22.
Hutson JR, Matlow JN, Moretti ME, Koren G. The fetal safety of thiopurines for the treatment of inflammatory bowel disease in pregnancy. J Obstet Gynaecol (Lahore). 2013;33:1-8.
Bortoli A,Pedersen N, Duricova D, et al. Pregnancy outcome in inflammatory bowel disease: prospective European case-control ECCO-EpiCom study, 2003-2006. Aliment Pharmacol Ther. 2011;34:724-734.
Casanova MJ, Chaparro M, Domènech E, et al. Safety of thiopurines and Anti-TNF-α drugs during pregnancy in patients with inflammatory bowel disease. Am J Gastroenterol. 2013;108:433-440.
Coelho J, Beaugerie L, Colombel JF, et al. Pregnancy outcome in patients with inflammatory bowel disease treated with thiopurines: cohort from the CESAME study. Gut. 2011;60:198-203.
Ediger JP, Walker JR, Graff L, et al. Predictors of medication adherence in inflammatory bowel disease. Am J Gastroenterol. 2007;102:1417-1426.
De Lima A, Zelinkova Z, Mulders AGMGJ, Van Der Woude CJ. Preconception care reduces relapse of inflammatory bowel disease during pregnancy. Clin Gastroenterol Hepatol. 2016;14:1285-1292.
Karve S, Cleves MA, Helm M, Hudson TJ, West DS, Martin BC. An empirical basis for standardizing adherence measures derived from administrative claims data among diabetic patients. Med Care. 2008;46:1125-1133.