Jiří Vlček

Nonadherence in inflammatory bowel disease: Results of factor analysis

Background: The purpose of the study was to assess overall nonadherence to treatment among patients with Crohns disease (CD) and ulcerative colitis (UC) in a single tertiary center. Methods: A total of 177 patients were enrolled in this study (84 males, 93 females; 117 CD, 60 UC). Patients were interviewed about their nonadherent behavior and their answers were analyzed using factor analysis. Urine samples were collected from a subcohort of 47 patients treated by mesalamine to verify the presence of 5‐ASA or its metabolites. Results: Overall intentional nonadherence was reported by 38.9% of patients; 18.6% of the patients discontinued the treatment at least once. Intentional dose reduction was reported by 18% of patients; 14.7% of patients occasionally did not refill their medications on time. There were no differences in adherence between males and females, disease type, previous bowel surgery, or marital, smoking, and nonsmoking status. More than 38% of patients reported unintentional nonadherence. Factor analysis proved that nonadherence increased with a higher education level of the patients and decreased with older age. Adverse drug effects strongly contributed to nonadherence. Nonadherent patients were more likely to be chronically active or in relapse (&tgr; = 0.212; P = 0.002). In the group of 47 patients whose urine was analyzed, 6 cases (12.7%) were negative for mesalamine or its metabolite. Conclusions: The overall intentional nonadherence with medical therapy is relatively high among IBD patients and should be taken into account when a patients response to treatment is unsatisfactory. Therefore, problems of nonadherence should be discussed with all IBD patients. (Inflamm Bowel Dis 2007)

Cytochrome P450 enzyme regulation by glucocorticoids and consequences in terms of drug interaction

Introduction: Due to their multiple effects, glucocorticoids (GCs) have versatile medical uses. They can regulate many xenobiotic-metabolizing enzymes of the cytochrome P450 (CYP) superfamily, and thus, influence pharmacotherapy. Areas covered: The aim of this paper is to summarize the molecular effects of GCs on CYP as well as the available clinical evidence on drug–drug interactions (DDIs) between GCs and other drugs in which GCs influence the metabolism of other medicines through modifying CYP activity. We used the factographic database DRUGDEX® along with bibliographic searches. Expert opinion: Most of the literature reported CYP3A4 induction by GCs, but this was not proved in all research. As the conclusions on these DDIs are conflicting, there are several issues to be considered like the dosage of GCs, the length of GCs treatment and concomitant therapy, all of which can have an additive inducing effect. Further, in designing a DDI study, crossover studies are preferred. A literature search of the abovementioned information resources provided dissimilar results.

Monitoring of TPN consumption at the University Teaching Hospital in Hradec Králové

To standardize studies on the utilization and consumption of drugs, the World Health Organization recommends the use of the Anatomical Therapeutic Chemical (ATC) classification system, using the defined daily dose (DDD value) as a technical unit of measurement of drug consumption, DDD values of total parenteral nutrition have not been established yet. In our descriptive study the methodology by E. Frankfort et al. (1993) [3] is used. This methodology allows the calculation of both the total number of DDD values for TPN and the number of DDD values for the individual substances. Suggested DDD values and consumption of total parenteral nutrition by E. Frankfort et al. (1994) [4] were compared with the values at the Teaching Hospital in Hradec Králové. During 3 months 142 patients administered only TPN were included in the study. The following data from every patient were collected: sex, age, the main diagnosis, composition of TPN each day and duration of this administration. The mean PDD value for carbohydrates was 200 ± 41 g. for fat emulsion 77 ± 27 g and for amino acids 93 ± 16 g. The difference between our and Frankforts results were found.