{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T12:34:58Z","timestamp":1754397298870},"reference-count":24,"publisher":"The Journal of Rheumatology","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"published-print":{"date-parts":[[2017,10]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>To evaluate a classification system to define adherence to axial spondyloarthritis (axSpA) anti-tumor necrosis factor (anti-TNF) use recommendations and examine the effect of adherence on outcomes in the DESIR cohort (Devenir des Spondylarthropathies Indiff\u00e9renci\u00e9es R\u00e9centes).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>Using alternate definitions of adherence, patients were classified as adherent \u201ctimely\u201d anti-TNF users, nonadherent \u201clate\u201d anti-TNF users, adherent nonusers (\u201cno anti-TNF need\u201d), non-adherent nonusers (\u201cunmet anti-TNF need\u201d). Multivariate models were fitted to examine the effect of adherence on quality-adjusted life-years (QALY), total costs, and nonbiologic costs 1 year following an index date. Generalized linear regression models assuming a \u03b3-distribution with log link were used for costs outcomes and linear regression models for QALY outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>Using the main definition of adherence, there were no significant differences between late anti-TNF users and timely anti-TNF users in total costs (RR 0.86, 95% CI 0.54\u20131.36, p = 0.516) or nonbiologic costs (RR 0.72, 95% CI 0.44\u20131.18, p = 0.187). However, in the sensitivity analysis, late anti-TNF users had significantly increased nonbiologic costs compared with timely users (RR 1.58, 95% CI 1.06\u20132.36, p = 0.026). In the main analysis, there were no significant differences in QALY between timely anti-TNF users and late anti-TNF users, or between timely users and patients with unmet anti-TNF need. In the sensitivity analysis, patients with unmet anti-TNF need had significantly lower QALY than timely anti-TNF users (\u22120.04, 95% CI \u22120.07 to \u22120.01, p = 0.016).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion.<\/jats:title><jats:p>The effect of adherence to anti-TNF recommendations on outcomes was sensitive to the definition of adherence used, highlighting the need to validate methods to measure adherence.<\/jats:p><\/jats:sec>","DOI":"10.3899\/jrheum.161399","type":"journal-article","created":{"date-parts":[[2017,7,2]],"date-time":"2017-07-02T00:20:11Z","timestamp":1498954811000},"page":"1436-1444","source":"Crossref","is-referenced-by-count":3,"title":["Adherence to Antitumor Necrosis Factor Use Recommendations in Spondyloarthritis: Measurement and Effect in the DESIR 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