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Anja St.Clair Jones, lead pharmacist gastroenterology, Brighton and Sussex University Hospitals NHS Trust, explains how pharmacists can help IBD patients

IBD and mesalazine

In the current economic climate CCGs are keen that patients with inflammatory bowel disease (IBD) be switched to a cheaper brand of mesalazine. However a Scottish study shows that such a policy may prove to be counterproductive if the cost of flares negates the savings made by the switch.

The study, which looked at UK dispensing data for mesalazine (n=1,200), reported that only 39 per cent of ulcerative colitis (UC) patients in the matched samples were classed as adherent. Adherence was measured as ratio of intended prescription duration to the actual interval between prescription refills.

Preparations and formulations did not affect adherence and non-adherent patients had, as expected, a higher risk of flares with a relative ratio (RR) of 1.44 over a mean of 600 days follow-up.

Maintenance of remission is of the utmost importance

The investigators also looked at a sub-group of adherent patients who switched mesalazine formulation and found they had a higher incidence of flare than a control group with a RR of 3.5, indicating that switching is associated with a significantly increased risk of relapse in adherent patients.

Compliance support

In view of the importance of adherence to maintenance therapy, pharmacists must focus on compliance support, as adherence has been shown to be the most important contributing factor to managing IBD flares. Maintenance of remission is of the utmost importance for the patient and the health economy.

Young patients

The young UC patient on mesalazine, in particular, seems to be at high risk of non-adherence and needs to be supported through appropriate information, tailored treatment choices and adherence reminders in the form of widely available patient support programmes. Pharmacists can help these patients by discussing self-management strategies.

Current British Society of Gastroenterologists IBD guidelines recommend ≥2g daily of mesalazine to maintain remission, increased to ≥4g mesalazine for six weeks in a flare prior to stepping up to steroids.

Patients are encouraged to increase the dose of mesalazine as soon as they experience any sign of flare without having to contact the prescriber.

The importance of taking maintenance therapy even when in remission should be emphasised as there is a definite link with adherence to mesalazine and significant lower risk of colorectal cancer, a long-term risk of inflammatory bowel disease.

As pharmacists, our input towards compliance can make a significant difference in this small but costly patient cohort. The best mesalazine is the one the patient takes. So let’s help them to take it