Optimizing 5-Aminosalicylic Acid Maintenance Treatment in Ulcerative Colitis from the Patient and Physician Perspective: A Cross-sectional Multicenter Study

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Background: There are currently no standardized guidelines for optimizing 5-aminosalicylic acid (5-ASA) maintenance treatment, particularly in patients with ulcerative colitis (UC) who have achieved clinical remission (CR). Therefore, this study examined the perspectives of patients and physicians regarding 5-ASA dose reduction and medication adherence to optimize maintenance treatment. Methods: This cross-sectional study was conducted from February 2023 to May 2023 at 19 institutions and included patients with UC and physicians. The participants' perspectives were assessed using an anonymous questionnaire. Results: This study included 369 patients with UC (female, 43.1%; age, > 60 years, 29.3%; CR, 88.9%). Preference to reduce the 5-ASA dose and low medication adherence were observed in 46.1% and 16.0% of patients, respectively. Low medication adherence (odds ratio [OR]: 3.43, 95% confidence interval [CI]: 1.67-7.03) was associated with the preference to reduce the 5-ASA dose. Multivariate analysis for factors associated with low medication adherence revealed age < 60 years (OR: 10.25, 95% CI: 3.58-29.38), no intractable disease subsidy (OR: 2.63, 95% CI: 1.09-6.35), dosing frequency ≥ 2 times/day (OR: 9.04, 95% CI: 3.67-22.25), and preference to reduce the 5-ASA dose (OR: 2.57, 95% CI: 1.16-5.70) as significant. Among 153 physicians, 62.7% had > 10 years of experience, and 51.0% regularly verified adherence, with experience being a significant factor (OR: 2.01, 95% CI: 1.10-3.68). Conclusions: Factors influencing medication adherence with 5-ASA included patients' desire for dose reduction and physicians' lack of experience. Improving communication with patients and enhancing education for physicians could help optimize treatment with 5-ASA.