Treatment Profile of Pediatric Inflammatory Bowel Disease in Saudi Arabia: Issues in Treatment Adherence

Background: Inflammatory bowel disease (IBD), with its 3 subgroups: Crohn's disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC), is a chronic relapsing inflammatory disorder of the gastrointestinal (GI) tract. Medication adherence is particularly problematic in pediatric IBD. To date this has not been studied in the Middle East. Objectives: The aim of this study was to describe the treatment modalities of IBD and to evaluate adherence to treatment in a population-based cohort of Saudi children. Methods: A cross-sectional study was conducted in all regions of Saudi Arabia. All participating centers were asked to provide information on IBD medications and adherence to prescribed therapies. Results: 354 children with IBD were identified from our database. The age at diagnosis ranged from 1to 14 years, with 145 (41%) diagnosed with UC, 195 (55%) with CD and 14 (4%) with IC. The most common drugs therapy used in IBD was corticosteroids in CD and 5-ASA in UC. Patients with UC were treated with 5-ASA significantly more than patients with CD (76% vs. 62%; P= 0.004). In contrast, patients with CD were treated with infliximab significantly more than patients with UC (22% vs. 6%; P= 0.000). Overall, 15.8% of patients were non-adherent with patients with CD demonstrating a higher level of nonadherence, although this was not significantly different from UC patients (11% vs. 3.8%; P>0.05). Poor adherence to specific drugs was reported significantly more in CD than UC patients; mesalamine (p= 0.022), steroids (p= 0.021) and thiopurines (p= 0.006). Conclusion: Poor adherence occurs most frequently in CD patients and with 5-ASA, corticosteroids and thiopurines. These data can be used to help care providers and policy makers such as the Ministry Of Health define and quantify the burden of IBD among children in Saudi Arabia. Further research in IBD is required to determine the reasons for nonadherence/ poor adherence in the pediatric IBD population so that strategies can be devised to reduce it. Key Points: Medication adherence is particularly problematic in pediatric inflammatory bowel disease (IBD). We found that steroids and 5- Amino salicylic acids are the most widely used medications in pediatric IBD patients. Nonadherence occurs most frequently with 5-ASA, steroids and thiopurines in Crohns. These data should help health care providers quantify the burden of IBD among children.