human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction Benefits of disease-modifying anti-rheumatic drugs ( DMARD ) in early rheumatoid arthritis patients ( ERAP ) will be achieved if patients follow prescribed treatment . Objective was to investigate whether timing of first non-persistence period and /or duration of persistence during the first 4 years of follow-up predicted disease outcomes at the 5th year in a cohort of ERAP , initiated in 2004 . Patients and Methods Up to February 2015 , charts of 107 ERAP with at least 5 years of follow-up and prospect i ve 6-month assessment s of disease activity , disability and persistence were review ed . Non-persistence was defined as omission of DMARD and /or corticosteroids for at least 7 consecutive days ; regarding methotrexate , one weekly missing dose was considered non-persistence . Persistence was recorded through an interview ( up to 2008 ) and thereafter through a question naire ; persistence duration was recorded in months of continuous medicationtaking . At the 5th year , disease activity was defined according to Disease Activity Score (DAS)28 , and disability according to Health Assessment Question naire ( HAQ ) . Descriptive statistics and linear and Cox regression analyses were used . Results At study entry , patients were more frequently middle-aged ( 39.1 ± 13.3 years ) and female ( 88.8 % ) , as well as more likely to have  high disease activity and disability . Over the first 4 years of follow-up , 54.2 % of the patients had indications for oral corticosteroids and all traditional DMARDs . Almost 70 % had at least one period of non-persistence , and their follow-up ( median , 25th–75th interquartile range ) to first non-persistence period was 13 months ( 1–31 ) . Persistence duration during the first 4 years predicted subsequent DAS28 ( in addition to gender and baseline DAS28 ) and HAQ ( in addition to age ) . During the 5th year , 68 patients ( 56 women )  achieved sustained remission ( DAS28 < 2.6 ) . In female population ( n = 95 ) , baseline DAS28 ( odds ratio [ OR ] , 0.65 ; 95 % confidence interval [ CI ] , 0.50–0.83 ; p = 0.001 ) and persistence duration ( OR , 1.04 ; 95 % CI , 1–1.08 ; p = 0.05 ) were predictors . Also , 84 patients  achieved sustained function ( HAQ < 0.21 ) , and baseline DAS28 and age were the only predictors . Timing of first non-persistence period did not impact outcomes . Conclusions Persistence duration with DMARDs within the first 4 years of RA predicted subsequent favorable outcomes in ERAP ; additional predictors were younger age , male gender and lower disease activity at diagnosis OBJECTIVE To study the influence of rheumatologists ' adherence to a methotrexate guideline on efficacy and toxicity in the treatment of rheumatoid arthritis . METHODS In a 48 week r and omised controlled trial of methotrexate , comparing folates with placebo , rheumatologists were advised on methotrexate dosage using a guideline reflecting daily practice . The influence of guideline non-adherence on outcome was analysed using generalised estimating equations and survival analysis . RESULTS In 51 % of the 411 study patients the guidelines were always followed . Non-adherence result ed in lower doses of methotrexate  in 25 % of cases , and higher doses in 24 % . The reduction in the disease activity score was significantly greater ( mean -0.4 ; p = 0.0085 ) in the adherent group than in the " low dose " group ; the " high dose " group did not differ from the adherent group . Dropout caused by severe adverse events did not differ between the three groups . CONCLUSIONS There is an indication that adherence to guidelines on methotrexate dosage may benefit patients with rheumatoid arthritis by improving disease activity without increasing toxicity . For definite proof , a r and omised controlled trial comparing guideline supported dosing with usual care is needed Objective . Non-adherence to DMARDs is common , but little is known about adherence to biologic therapies and its relationship to treatment response . The purpose of this study was to investigate the association between self-reported non-adherence to s.c . anti-TNF therapy and response in individuals with RA . Methods . Participants about to start s.c . anti-TNF therapy were recruited to a large UK multicentre prospect i ve observational cohort study . Demographic information and disease characteristics were assessed at baseline . Self-reported non-adherence , defined as whether the previous due dose of biologic therapy was reported as not taken on the day agreed with the health care professional , was recorded at 3 and 6 months following the start of therapy . The 28-joint DAS ( DAS28 ) was recorded at baseline and following 3 and 6 months of therapy . Multivariate linear regression was used to examine these relationships . Results . Three hundred and ninety-two patients with a median disease duration of 7 years [ interquartile range ( IQR ) 3–15 ] were recruited .  Adherence data were available in 286 patients . Of these , 27 % reported non-adherence to biologic therapy  according to the defined criteria at least once within the first 6-month period . In multivariate linear regression analysis , older age , lower baseline DAS28 and ever non-adherence at either 3 or 6 months from baseline were significantly associated with a poorer DAS28 response at 6 months to anti-TNF therapy . Conclusion . Patients with RA who reported not taking their biologic on the day agreed with their health care professional showed poorer clinical outcomes than their counterparts , emphasizing the need to investigate causes of non-adherence to biologics Background : Reports on adherence among patients with rheumatoid arthritis ( RA ) in Egypt and the Middle East region are lacking . This study aim ed to measure adherence to treatment among a sample of patients with RA at Ain Shams University Rheumatology outpatient clinic and to assess factors affecting it . Methods : A cross-sectional descriptive study was carried out at the rheumatology outpatient clinic on a sample of 140 patients with RA .  An interview question naire was used to measure adherence using the 8-item Morisky 's scale , factors affecting adherence to treatment like patients satisfaction were assessed using the short form patient satisfaction question naire , also patients ' knowledge , beliefs and rate of prescription refilling were assessed . Disease Activity Score—28 was used as an objective method to assess RA disease activity . Results : According to Morisky 's scale , 90.6 % and 9.4 % were classified as low and moderately adherent , respectively , none was classified as highly adherent to treatment . Important barriers to adherence reported were fear of side effects , nonavailability of free drugs in hospital pharmacy and cost of medications .  Younger patients ( P = 0.002 ) and those reporting greater general satisfaction ( P = 0.02 ) were more likely to be adherent . In addition , on-time refill rates of medication ( P = 0.001 ) and disease activity ( P = 0.02 ) were associated with higher adherence scores and thus further vali date d the results of the adherence question naire . Conclusions : Higher adherence was associated with more positive beliefs on medication , greater satisfaction with health care and less disease activity 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction Benefits of disease-modifying anti-rheumatic drugs ( DMARD ) in early rheumatoid arthritis patients ( ERAP ) will be achieved if patients follow prescribed treatment . Objective was to investigate whether timing of first non-persistence period and /or duration of persistence during the first 4 years of follow-up predicted disease outcomes at the 5th year in a cohort of ERAP , initiated in 2004 . Patients and Methods Up to February 2015 , charts of 107 ERAP with at least 5 years of follow-up and prospect i ve 6-month assessment s of disease activity , disability and persistence were review ed . Non-persistence was defined as omission of DMARD and /or corticosteroids for at least 7 consecutive days ; regarding methotrexate , one weekly missing dose was considered non-persistence . Persistence was recorded through an interview ( up to 2008 ) and thereafter through a question naire ; persistence duration was recorded in months of continuous medicationtaking . At the 5th year , disease activity was defined according to Disease Activity Score (DAS)28 , and disability according to Health Assessment Question naire ( HAQ ) . Descriptive statistics and linear and Cox regression analyses were used . Results At study entry , patients were more frequently middle-aged ( 39.1 ± 13.3 years ) and female ( 88.8 % ) , as well as more likely to have  high disease activity and disability . Over the first 4 years of follow-up , 54.2 % of the patients had indications for oral corticosteroids and all traditional DMARDs . Almost 70 % had at least one period of non-persistence , and their follow-up ( median , 25th–75th interquartile range ) to first non-persistence period was 13 months ( 1–31 ) . Persistence duration during the first 4 years predicted subsequent DAS28 ( in addition to gender and baseline DAS28 ) and HAQ ( in addition to age ) . During the 5th year , 68 patients ( 56 women )  achieved sustained remission ( DAS28 < 2.6 ) . In female population ( n = 95 ) , baseline DAS28 ( odds ratio [ OR ] , 0.65 ; 95 % confidence interval [ CI ] , 0.50–0.83 ; p = 0.001 ) and persistence duration ( OR , 1.04 ; 95 % CI , 1–1.08 ; p = 0.05 ) were predictors . Also , 84 patients  achieved sustained function ( HAQ < 0.21 ) , and baseline DAS28 and age were the only predictors . Timing of first non-persistence period did not impact outcomes . Conclusions Persistence duration with DMARDs within the first 4 years of RA predicted subsequent favorable outcomes in ERAP ; additional predictors were younger age , male gender and lower disease activity at diagnosis OBJECTIVE To study the influence of rheumatologists ' adherence to a methotrexate guideline on efficacy and toxicity in the treatment of rheumatoid arthritis . METHODS In a 48 week r and omised controlled trial of methotrexate , comparing folates with placebo , rheumatologists were advised on methotrexate dosage using a guideline reflecting daily practice . The influence of guideline non-adherence on outcome was analysed using generalised estimating equations and survival analysis . RESULTS In 51 % of the 411 study patients the guidelines were always followed . Non-adherence result ed in lower doses of methotrexate  in 25 % of cases , and higher doses in 24 % . The reduction in the disease activity score was significantly greater ( mean -0.4 ; p = 0.0085 ) in the adherent group than in the " low dose " group ; the " high dose " group did not differ from the adherent group . Dropout caused by severe adverse events did not differ between the three groups . CONCLUSIONS There is an indication that adherence to guidelines on methotrexate dosage may benefit patients with rheumatoid arthritis by improving disease activity without increasing toxicity . For definite proof , a r and omised controlled trial comparing guideline supported dosing with usual care is needed Objective . Non-adherence to DMARDs is common , but little is known about adherence to biologic therapies and its relationship to treatment response . The purpose of this study was to investigate the association between self-reported non-adherence to s.c . anti-TNF therapy and response in individuals with RA . Methods . Participants about to start s.c . anti-TNF therapy were recruited to a large UK multicentre prospect i ve observational cohort study . Demographic information and disease characteristics were assessed at baseline . Self-reported non-adherence , defined as whether the previous due dose of biologic therapy was reported as not taken on the day agreed with the health care professional , was recorded at 3 and 6 months following the start of therapy . The 28-joint DAS ( DAS28 ) was recorded at baseline and following 3 and 6 months of therapy . Multivariate linear regression was used to examine these relationships . Results . Three hundred and ninety-two patients with a median disease duration of 7 years [ interquartile range ( IQR ) 3–15 ] were recruited .  Adherence data were available in 286 patients . Of these , 27 % reported non-adherence to biologic therapy  according to the defined criteria at least once within the first 6-month period . In multivariate linear regression analysis , older age , lower baseline DAS28 and ever non-adherence at either 3 or 6 months from baseline were significantly associated with a poorer DAS28 response at 6 months to anti-TNF therapy . Conclusion . Patients with RA who reported not taking their biologic on the day agreed with their health care professional showed poorer clinical outcomes than their counterparts , emphasizing the need to investigate causes of non-adherence to biologics Background : Reports on adherence among patients with rheumatoid arthritis ( RA ) in Egypt and the Middle East region are lacking . This study aim ed to measure adherence to treatment among a sample of patients with RA at Ain Shams University Rheumatology outpatient clinic and to assess factors affecting it . Methods : A cross-sectional descriptive study was carried out at the rheumatology outpatient clinic on a sample of 140 patients with RA .  An interview question naire was used to measure adherence using the 8-item Morisky 's scale , factors affecting adherence to treatment like patients satisfaction were assessed using the short form patient satisfaction question naire , also patients ' knowledge , beliefs and rate of prescription refilling were assessed . Disease Activity Score—28 was used as an objective method to assess RA disease activity . Results : According to Morisky 's scale , 90.6 % and 9.4 % were classified as low and moderately adherent , respectively , none was classified as highly adherent to treatment . Important barriers to adherence reported were fear of side effects , nonavailability of free drugs in hospital pharmacy and cost of medications .  Younger patients ( P = 0.002 ) and those reporting greater general satisfaction ( P = 0.02 ) were more likely to be adherent . In addition , on-time refill rates of medication ( P = 0.001 ) and disease activity ( P = 0.02 ) were associated with higher adherence scores and thus further vali date d the results of the adherence question naire . Conclusions : Higher adherence was associated with more positive beliefs on medication , greater satisfaction with health care and less disease activity 
    Output:
    