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TOPLINE:

Patients with autoimmune liver diseases reported non-adherence to prescribed therapies, with those with autoimmune hepatitis (AIH) reporting the highest rate of non‐adherence. The use of over-the-counter medications and steroids was negatively associated with treatment adherence.

METHODOLOGY:

• Researchers analysed data from a cross-sectional online survey to compare treatment adherence among patients with AIH, primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) and identify disease- and patient-related factors affecting compliance.
• They included 1097 non-transplanted adult patients with autoimmune liver diseases (mean age, 48 years; 79.67% women) from 15 European countries who had AIH (n = 444), PBC (n = 377), or PSC (n = 276) and were taking prescribed pharmacotherapy for disease management.
• The survey used a questionnaire to collect patient-reported data, including health-related quality of life, somatic symptom burden, anxiety and depression, access to medical care, and prescribed and over-the-counter medications.
• Patient adherence was classified as a binary variable, with non-adherence defined as skipping medication at least once weekly or a self-initiated dose reduction or discontinuation.

TAKEAWAY:

• Overall, 271 (24.7%) patients reported taking over-the-counter medications, most commonly in patients with PSC (28.3%), followed by those with PBC and AIH (25.2% and 22.1%, respectively).
• Patients with AIH had the highest rate of non-adherence (47%; 95% CI, 43%-52%), followed by those with PSC (38%; 95% CI, 33%-44%) and PBC (29%; 95% CI, 24%-33%).
• The use of over-the-counter medications was negatively associated with treatment adherence across all patient groups (odds ratio [OR], 0.50; 95% CI, 0.36-0.68), particularly among patients with AIH (OR, 0.48; 95% CI, 0.29-0.80).
• Among patients with AIH, treatment with steroids, but not azathioprine, was associated with reduced adherence (OR, 0.52; 95% CI, 0.32-0.84), and among patients with PBC and PSC, treatment with ursodeoxycholic acid was associated with increased adherence (OR, 3.0; 95% CI, 0.66-12.8 and OR, 5.2; 95% CI, 1.4-20.8, respectively).

IN PRACTICE:

"Our data strongly supports the need for the careful assessment of patient adherence as an essential part of routine medical management. Following the results presented here, physicians should recognize skeptical patient attitude to conservative therapy and focus on the use of alternative medicines by their patients," the authors of the study wrote.

SOURCE:

This study was led by Ewa Wunsch, Pomeranian Medical University in Szczecin, Szczecin, Poland, and Linda Krause, Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf in Hamburg, Germany. It was published online on August 01, 2025, in United European Gastroenterology Journal.

LIMITATIONS:

A universal tool and measurement criteria for treatment adherence were lacking. The anonymous online format prevented participants from clarifying the questionnaire's content or discussing reasons for low persistence with study providers. The researchers could not draw causal associations or conclusively uncover the causes of patient non-compliance. Additionally, other potential influences on treatment compliance, including economic, social, or healthcare system issues, were not identified in this study.

DISCLOSURES:

This study was supported by a grant from the Consumers, Health, Agriculture and Food Executive Agency. The authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.