Clinical impact and drivers of non-adherence to maintenance medication for inflammatory bowel disease

Introduction: Inflammatory bowel diseases (IBDs) require maintenance medication to sustain remission and as a prophylaxis against the development of colorectal dysplasia. Non-adherence can compromise the effectiveness of treatment plans. Areas covered: Depending on study cohort and country, 7 72% of IBD patients do not adhere to maintenance medication plans. Non-adherence is associated with an increased number of flares and increased healthcare utilization costs. Several factors, such as experiencing side effects and demographic, socioeconomic, disease-specific and psychological variables have been associated with non-adherence in IBD. Data on demographic, socioeconomic and disease-specific variables are inconsistent, while data on psychological distress, patients' beliefs about medication and discordant doctorpatient relationships are more consistently associated with non-adherence. There has been a change towards investigation of modifiable factors for non-adherence in the recent literature. Expert opinion: Currently, there is no simple and effective intervention to improve adherence to IBD maintenance medication. Anxiety, beliefs about medicines and the doctorpatient relationship are promising targets for interventions, but require further study.