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Measures of adherence in patients with severe asthma prescribed systemic steroids in the U-BIOPRED cohort

Measures of adherence in patients with severe asthma prescribed systemic steroids in the U-BIOPRED cohort
Measures of adherence in patients with severe asthma prescribed systemic steroids in the U-BIOPRED cohort
Introduction: Rates of sub-optimal adherence to medications in asthma range up to 70%; the impact in severe asthma is likely to be particularly high. We measured self-reported adherence in participants in the U-BIOPRED cohort prescribed daily prednisolone using the Medication Adherence Response Scale (MARS), and compared to measured urinary prednisolone and metabolites in order to determine: 1. the prevalence of suboptimal adherence by each method; 2. the ability of MARS to predict urinary steroid detection.Methods: Participants completed the MARS, and/or provided urine samples (analysed for prednisolone and metabolites by LCMS). The performance characteristics of the MARS predicting undetected urinary steroid were calculated in the subgroup having both tests.Results: 181 participants currently taking regular oral corticosteroids were included, 59% female, mean (SD) age 54(12)yrs, FEV1 64.7(20.4)% predicted. Sub-optimal adherence (MARS score < 4.5) was reported in 62 participants, and 76 did not have detectable urinary prednisolone or metabolites. Good adherence by both methods was detected in only 52 participants (34%, see table). There was no difference in daily prednisolone dose between detectable and undetectable metabolites groups (p=0.848).Conclusion: Low levels of adherence to treatment in severe asthma is a common problem, when measured either directly or self-reported. There was very poor agreement (48% concordance) between these two methods, and we suggest that, for now both approaches should be used.
0903-1936
Alahmadi, Fahad
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Simpson, Andrew
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Gomez, Christina
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Wheelock, Craig
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Shaw, Dominick
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Fleming, Louise
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Roberts, Graham
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Riley, John
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Bates, Stewart
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Sousa, Ana R.
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Knowles, Richard
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Bansal, Aruna
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Corfield, Julie
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Pandis, Ioannis
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Sun, Kai
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Bakke, Per
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Caruso, Massimo
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Chanez, Pascal
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Dahlen, Babro
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Horvath, Ildiko
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Krug, Norbert
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Montuschi, Paolo
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Sandstrom, Thomas
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Singer, Florian
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Wagers, Scott
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Adcock, Ian
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Djukanovic, Ratko
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Chung, Kian
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Sterk, Peter J.
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Dahlen, Sven-Erik
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Fowler, Stephen J.
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Alahmadi, Fahad
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Simpson, Andrew
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Gomez, Christina
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Wheelock, Craig
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Shaw, Dominick
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Fleming, Louise
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Roberts, Graham
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Riley, John
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Bates, Stewart
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Sousa, Ana R.
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Knowles, Richard
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Bansal, Aruna
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Corfield, Julie
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Pandis, Ioannis
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Sun, Kai
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Bakke, Per
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Caruso, Massimo
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Chanez, Pascal
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Dahlen, Babro
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Horvath, Ildiko
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Krug, Norbert
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Montuschi, Paolo
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Sandstrom, Thomas
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Singer, Florian
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Wagers, Scott
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Adcock, Ian
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Djukanovic, Ratko
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Chung, Kian
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Sterk, Peter J.
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Dahlen, Sven-Erik
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Fowler, Stephen J.
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Alahmadi, Fahad, Simpson, Andrew, Gomez, Christina, Wheelock, Craig, Shaw, Dominick, Fleming, Louise, Roberts, Graham, Riley, John, Bates, Stewart, Sousa, Ana R., Knowles, Richard, Bansal, Aruna, Corfield, Julie, Pandis, Ioannis, Sun, Kai, Bakke, Per, Caruso, Massimo, Chanez, Pascal, Dahlen, Babro, Horvath, Ildiko, Krug, Norbert, Montuschi, Paolo, Sandstrom, Thomas, Singer, Florian, Wagers, Scott, Adcock, Ian, Djukanovic, Ratko, Chung, Kian, Sterk, Peter J., Dahlen, Sven-Erik and Fowler, Stephen J. (2018) Measures of adherence in patients with severe asthma prescribed systemic steroids in the U-BIOPRED cohort. European Respiratory Journal, 52 (suppl 62), [PA3992]. (doi:10.1183/13993003.congress-2018.PA3992).

Record type: Meeting abstract

Abstract

Introduction: Rates of sub-optimal adherence to medications in asthma range up to 70%; the impact in severe asthma is likely to be particularly high. We measured self-reported adherence in participants in the U-BIOPRED cohort prescribed daily prednisolone using the Medication Adherence Response Scale (MARS), and compared to measured urinary prednisolone and metabolites in order to determine: 1. the prevalence of suboptimal adherence by each method; 2. the ability of MARS to predict urinary steroid detection.Methods: Participants completed the MARS, and/or provided urine samples (analysed for prednisolone and metabolites by LCMS). The performance characteristics of the MARS predicting undetected urinary steroid were calculated in the subgroup having both tests.Results: 181 participants currently taking regular oral corticosteroids were included, 59% female, mean (SD) age 54(12)yrs, FEV1 64.7(20.4)% predicted. Sub-optimal adherence (MARS score < 4.5) was reported in 62 participants, and 76 did not have detectable urinary prednisolone or metabolites. Good adherence by both methods was detected in only 52 participants (34%, see table). There was no difference in daily prednisolone dose between detectable and undetectable metabolites groups (p=0.848).Conclusion: Low levels of adherence to treatment in severe asthma is a common problem, when measured either directly or self-reported. There was very poor agreement (48% concordance) between these two methods, and we suggest that, for now both approaches should be used.

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e-pub ahead of print date: 19 November 2018

Identifiers

Local EPrints ID: 430573
URI: http://eprints.soton.ac.uk/id/eprint/430573
ISSN: 0903-1936
PURE UUID: 4e2c3be4-f6e7-448d-8dc9-e40bfc772c4c
ORCID for Ratko Djukanovic: ORCID iD orcid.org/0000-0001-6039-5612

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Date deposited: 03 May 2019 16:30
Last modified: 04 May 2019 00:39

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Contributors

Author: Fahad Alahmadi
Author: Andrew Simpson
Author: Christina Gomez
Author: Craig Wheelock
Author: Dominick Shaw
Author: Louise Fleming
Author: Graham Roberts
Author: John Riley
Author: Stewart Bates
Author: Ana R. Sousa
Author: Richard Knowles
Author: Aruna Bansal
Author: Julie Corfield
Author: Ioannis Pandis
Author: Kai Sun
Author: Per Bakke
Author: Massimo Caruso
Author: Pascal Chanez
Author: Babro Dahlen
Author: Ildiko Horvath
Author: Norbert Krug
Author: Paolo Montuschi
Author: Thomas Sandstrom
Author: Florian Singer
Author: Scott Wagers
Author: Ian Adcock
Author: Kian Chung
Author: Peter J. Sterk
Author: Sven-Erik Dahlen
Author: Stephen J. Fowler

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