Physician Perceptions of JAK Inhibitor Adherence in Inflammatory Bowel Disease: A Cross-Sectional AIGO Survey

Background and Objectives: Adherence to oral therapies in inflammatory bowel disease (IBD) is a critical determinant of treatment outcomes. Janus kinase inhibitors (JAKis) are an important therapeutic advancement in IBD management, offering oral, small-molecule alternatives to biological agents. However, little is known about how clinicians perceive and assess adherence to oral small-molecule therapies. This exploratory study aimed to examine how gastroenterologists perceive, assess, and address JAKi adherence. Materials and Methods: A structured 21-item web survey was administered by the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) to Italian IBD gastroenterologists in April 2025; 42 completed it. Respondents were characterized by years of experience (<10, 10–20, >20 years), hospital type, and IBD patient volume (<100, 100–500, >500 patients). The questionnaire addressed prescribing practices, adherence assessment methods, perceived barriers to adherence, and strategies to improve adherence. No patient-level adherence data were collected: all findings reflect physicians’ self-reported perceptions and practices. Primary analyses were restricted to the 38 respondents who had at least one patient treated with a JAKi. Proportions are reported with Wilson 95% confidence intervals; associations were explored with 279 pairwise Fisher’s exact tests, reported both uncorrected and after Benjamini–Hochberg false discovery rate (FDR) adjustment, and are hypothesis-generating. Results: Among the 38 JAKi prescribers, 86.8% (33/38; 95% CI 72.7–94.2%) considered adherence a clinical concern and all 38 (100%) reported assessing adherence in clinical practice; 37/38 (97.4%) reported doing so by direct verbal questioning and none reported using a questionnaire or validated scale. Forgetfulness (71.1%) and absence of symptoms (68.4%) were the most frequently perceived barriers; digital applications/reminders (71.1%) and dose simplification (63.2%) were the most endorsed interventions. No association was detected between adherence concern and years of IBD experience, hospital type, or patient volume in this small sample. Sixteen of 279 pairwise tests had an uncorrected p < 0.05 (14 expected by chance); none remained significant after FDR adjustment (smallest q = 0.24), and odds ratios had very wide confidence intervals. Small sample size, unknown response rate, a non-validated questionnaire, cross-sectional design, and the perception-based nature of the data limit inference and generalizability. Conclusions: Among the Italian gastroenterologists who responded to this survey and currently prescribe JAKi, adherence to oral therapy was a concern when prescribing a JAK inhibitor, and respondents reported routinely assessing adherence to therapies in clinical practice, mainly through unstructured verbal questioning. The exploratory associations among survey responses require confirmation in larger, patient-centred studies incorporating objective adherence measures.