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A separate multivariate model adjusting for the same factors, but looking at cumulative years of adherence that showed patients with less than 3 years good adherence (i.e., >80%), were at increased risk of death compared with patients having 5 years of good adherence.
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Five-year level (one-year) of adherence to therapy was 36%69%9%) for patients receiving infliximab in combination with MTX compared with 65%89%9%) for patients treated with etanercept and MTX (p < 0.001).
Data were computed up to a maximum of 5 years from the date of the first prescription refill, thus it could be considered a cumulative 5 years measure of adherence.
Women with low adherence are at greater risk of all-cause mortality, and fewer years of high adherence is also associated with increased breast cancer-specific mortality and recurrence.
However, fewer cumulative years of high adherence was associated with increased risk of recurrence, although this was only significant comparing 5 years against 3 or less.
On the other hand, the 1-year level of adherence to therapy found in our study closely resembles values found in randomised controlled clinical trials.
Third, the present four-year analysis of adherence shows a low rate of increase in adherence (from 22.9% in 2004 to 28.0% of newly treated subjects in 2007) suggesting the need for more effective interventions.
Also, patients treated with etanercept showed a 74% 1-year level of adherence to therapy compared with 76% in the TEMPO (Trial of Etanercept and Methotrexate with Radiographic Patient Outcomes) trial when given as monotherapy [ 9].
We found 1-year level of adherence to therapy for patients treated with infliximab and concomitant MTX to be approximately 70% compared with 73% in the ATTRACT (Anti-TNF Trial in Rheumatoid Arthritis with Concomitant Therapy) trial [ 2].
The 1-year level of adherence to therapy in this subgroup was similar to the complete adherence analysis, and when adjusting for age, gender, DAS28, HAQ score, disease duration, previous DMARDs, and CRP level, patients treated with infliximab had a threefold to fourfold increased risk for stopping therapy compared with etanercept (p < 0.001).
184 The excess risk is reduced with good dietary adherence and reduction in intestinal villous atrophy, and bone density increases during the first year of GFD adherence.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com