Improved Outcomes in Eosinophilic Esophagitis with Higher Medication Possession Ratio

Nathan T Kolasinski; Eric A Pasman; Cade M Nylund; Patrick T Reeves; Daniel I Brooks; Katerina G Lescouflair; Steve B Min

doi:10.3390/medicines11040008

Improved Outcomes in Eosinophilic Esophagitis with Higher Medication Possession Ratio

Medicines (Basel). 2024 Mar 26;11(4):8. doi: 10.3390/medicines11040008.

Authors

Nathan T Kolasinski^{1

2}, Eric A Pasman^{2

3}, Cade M Nylund^{1

2}, Patrick T Reeves^{1

2}, Daniel I Brooks⁴, Katerina G Lescouflair⁴, Steve B Min^{1

2}

Affiliations

¹ Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
² Department of Pediatrics, Uniformed Services University, Bethesda, MD 20889, USA.
³ Department of Pediatrics, Naval Medical Center San Diego, San Diego, CA 92134, USA.
⁴ Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.

Abstract

Eosinophilic esophagitis (EoE) disease activity can be caused by treatment non-adherence. Medication possession ratio (MPR) is an established metric of medication adherence. A higher MPR correlates with better outcomes in several chronic diseases, but MPR has not been investigated with respect to EoE. A retrospective cohort study was performed using an established EoE registry for the years 2005 to 2020. Treatment periods were identified, MPRs were calculated, and medical records were assessed for histologic remission (<15 eos/hpf), dysphagia, food impaction, stricture occurrence, and esophageal dilation that corresponded to each treatment period. In total, 275 treatment periods were included for analysis. The MPR in the histologic remission treatment period group was 0.91 (IQR 0.63-1) vs. 0.63 (IQR 0.31-0.95) for the non-remission treatment period group (p < 0.001). The optimal MPR cut-point for histologic remission was 0.7 (Sen 0.66, Spec 0.62, AUC 0.63). With MPRs ≥ 0.7, there were significantly increased odds of histologic remission (odds ratio 3.05, 95% confidence interval 1.79-5.30) and significantly decreased odds of dysphagia (OR 0.27, 95% CI 0.15-0.45), food impaction (OR 0.26, 95% CI 0.11-0.55), stricture occurrence (OR 0.52 95% CI 0.29-0.92), and esophageal dilation (OR 0.29, 95% CI 0.15-0.54). Assessing MPR before repeating an esophagogastroduodenoscopy may decrease unnecessary procedures in the clinical management of eosinophilic esophagitis.

Keywords: adherence; compliance; cost; eosinophilic esophagitis; medication possession ratio; safety.

Grants and funding

This work was prepared as part of the official duties of the authors, who are employed by the United States Department of Defense. Salary support was provided for all authors by the United States Department of Defense. The authors have no financial relationships relevant to this article to disclose. This research received no external funding.