Patients' beliefs about medicine are associated with early thiopurine discontinuation in patients with inflammatory bowel diseases

Mark M.T.J. Broekman, Marieke J H Coenen, Geert J A Wanten, Corine J van Marrewijk, Wietske Kievit, Olaf H Klungel, André L M Verbeek, Dennis R Wong, Piet M Hooymans, Henk-Jan Guchelaar, Hans Scheffer, Luc J J Derijks, Marcel L Bouvy, Dirk J. de Jong

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND: Patients' beliefs about medicine may either reflect the necessity for treatment or concerns regarding the treatment. We explored the extent to which these beliefs have an effect on thiopurine metabolite levels and premature discontinuation in patients with inflammatory bowel disease (IBD).

PATIENTS AND METHODS: Patients enrolled in the 'Thiopurine response Optimization by Pharmacogenetic testing in Inflammatory Bowel Disease Clinics' (TOPIC) trial were asked to complete the Beliefs about Medicine Questionnaire (BMQ) 4 weeks after thiopurine initiation. The BMQ measures perceptions about treatment necessity and concerns. On the basis of the necessity and concern scores, patients can be categorized as accepting, ambivalent, indifferent, or skeptical. The thiopurine discontinuation rates for these belief subgroups were compared by Kaplan-Meier curves. Furthermore, clinical response and metabolite levels were compared between the belief subgroups.

RESULTS: A total of 767 patients with IBD started thiopurine treatment, of whom 576 (75%) completed the BMQ. Patients could be classified as accepting (34%), indifferent (17%), ambivalent (34%), or skeptical (15%). Compared with patients in the accepting group (discontinuation rate 22%), patients with an indifferent (35%; P=0.02), ambivalent (37%; P<0.01), or skeptical belief (54%; P<0.01) had higher thiopurine discontinuation rates. No differences were observed in the steady-state thiopurine metabolite levels between the different belief subgroups.

CONCLUSION: Patients with a low perceived treatment necessity or high concerns toward IBD treatment were more likely to discontinue thiopurine treatment prematurely. Extra attention toward these patients might prevent premature discontinuation.

Original languageEnglish
Pages (from-to)167-173
Number of pages7
JournalEuropean Journal of Gastroenterology and Hepatology
Issue number2
Early online date11 Oct 2017
Publication statusPublished - Feb 2018


  • adherence
  • beliefs about medicine
  • inflammatory bowel disease
  • thiopurine


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