Canadian Study of Outcomes in Adalimumab Patients with Support for Adherence: Results from the COMPANION Study
Bibliographic record
Abstract
Introduction: Adalimumab (ADA) is a TNF-alpha inhibitor indicated for use in various inflammatory autoimmune diseases including Crohn's disease (CD) and ulcerative colitis (UC). Patients receiving ADA in Canada are eligible to enroll in a patient support program (PSP) providing personalized services including tailored interventions. This retrospective cohort study assessed the impact of specific factors, including PSP services and patient characteristics, on persistence and adherence to ADA. Methods: A patient linkage algorithm based on probabilistic matching was developed to link the ADA PSP database to the IMS Health longitudinal pharmacy transaction database, LRx. Patients that started ADA therapy between July 2010 and August 2014 were selected and their prescriptions were evaluated for 12 months after the index date to calculate days until end of persistence (>90 days without therapy), censored for patients who remained on therapy through month 12. Cox proportional hazards modelling provided hazard ratios (HR) for the association between persistence and patient characteristics and PSP services. Adherence, measured by medication possession ratio (MPR), was calculated and multivariable logistic regression provided adjusted odds ratios (OR) for the relationship between high adherence (MPR >= 80%) and patient characteristics and PSP services. Results: The linkage algorithm yielded a final sample of 10,857 patients (4,230 CD, 347 UC). Statistically significant differences in the hazard rate of discontinuation and the odds of high adherence were identified across multiple variables. Relative to the 30-39 year category, older age groups had significantly greater odds of adherence (OR = 1.247, 1.234, 1.323, 1.411, p < 0.01). Patients receiving ongoing motivational interventions, in the form of nurse-provided phone calls, were 72% less likely to cease therapy when compared to those that did not receive the interventions (HR = 0.282, p < 0.0001) and were also more adherent (OR = 1.483, p < 0.0001). Treatment abandonment (failure to initiate therapy after enrolment in the PSP) was >80% more frequent in patients that did not receive a pre-ADA intervention (p < 0.0001). Conclusion: Ongoing motivational interventions, as provided by the ADA PSP, were found to have a large and statistically significant association to greater patient persistence and adherence over the first 12 months of treatment. These results may help refine interventions aiming at improving treatment adherence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".