The Impact of Mesalazine Pill Burden on Compliance in Inflammatory Bowel Disease Patients

There are a limited number of studies that have investigated mesalazine persistence and adherence using administrative/pharmacy claims data that may approximate real-world clinical practice data; therefore, the aim of this study was to compare the adherence to oral mesalazine between different groups of inflammatory bowel disease (IBD) patients in relation to the tablet strength (number of pills per day) dispensed in retail pharmacy.

This was a retrospective cohort study in French patients using the IQVIA Longitudinal Prescription Data, a patient database based on retail pharmacy claims.

Of the 21,669 patients with a pharmacy claim for oral mesalazine initiated for IBD between June 2020 and April 2022, after exclusion criteria were applied, 12,122 IBD treatment-naïve patients initiating mesalazine treatment were included. A high-strength (HS) (1,600 mg), medium-strength (MS) (800-1,000 mg), and low-strength (LS) (400-500 mg) mesalazine tablet was dispensed to 1,216, 8,631, and 2,275 patients, respectively. Persistence to medication at 6 months of follow-up was 44.6%, 35.4%, and 25.3% in the HS, MS, and LS group, respectively. After 1 year of follow-up, it was 22.0%, 17.1%, and 11.5% in the HS, MS, and LS groups, respectively. Patient adherence to mesalazine tablets was 41.3% patients in the HS group, 35.5% patients in the MS group, and 28.0% patients in the LS group (p < 0.001).

The results showed a consistent higher adherence with the decrease of pill burden. HS tablets were significantly associated with higher persistence and higher adherence to medication compared to the MS and LS tablet group.