Dr Nawaf Al Mutairi — IBD medication adherence: why patients miss doses, what drives loss of adherence, and how to improve it
A focused clinical primer on one of the largest determinants of IBD outcomes — medication adherence. The reasons patients miss doses, the patterns of declining adherence over time, and the practical, evidence-based interventions that move the needle.
Topics covered
"Adherence is not a patient virtue — it is a system output, and the system is the clinician's to build."
Show notes
Dr Al Mutairi opens with the scale of the problem: across published cohorts, non-adherence to IBD maintenance therapy runs between 30% and 45% — and non-adherence carries a five-fold higher risk of clinical relapse. The patient in front of you who is "doing well on mesalazine" may, in reality, be taking it three days out of seven.
The middle minute walks through the common reasons patients miss doses: feeling well and questioning whether the medication is still needed, side-effect concerns (real or anticipated), the practical burden of multiple daily doses, cost and access issues, fear of long-term consequences of biologics or immunomodulators, and gaps in disease understanding. Each reason has a different remedy — making it the clinician's job to identify the specific driver in each patient, not to deliver a generic adherence lecture.
Dr Al Mutairi closes on what actually works: simplify the regimen wherever possible (once-daily formulations, combination products), pair every prescription with a short, plain-language explanation of why the patient is on it, schedule structured adherence check-ins at routine visits, use a shared decision-making framework when changing therapy, and integrate the IBD nurse and pharmacist into the patient's care loop. Adherence is not a patient virtue — it is a system output, and the system is the clinician's to build.