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A meta-analysis of the association between adherence to drug therapy and mortality
Open accessAbstract
OBJECTIVE: To evaluate the relation between adherence to drug therapy, including placebo, and mortality. DESIGN: Meta-analysis of observational studies. DATA SOURCES: Electronic databases, contact with investigators, and textbooks and reviews on adherence. Review methods Predefined criteria were used to select studies reporting mortality among participants with good and poor adherence to drug therapy. Data were extracted for disease, drug therapy groups, methods for measurement of adherence rate, definition for good adherence, and mortality. RESULTS: Data were available from 21 studies (46,847 participants), including eight studies with placebo arms (19,633 participants). Compared with poor adherence, good adherence was associated with lower mortality (odds ratio 0.56, 95% confidence interval 0.50 to 0.63). Good adherence to placebo was associated with lower mortality (0.56, 0.43 to 0.74), as was good adherence to beneficial drug therapy (0.55, 0.49 to 0.62). Good adherence to harmful drug therapy was associated with increased mortality (2.90, 1.04 to 8.11). CONCLUSION: Good adherence to drug therapy is associated with positive health outcomes. Moreover, the observed association between good adherence to placebo and mortality supports the existence of the "healthy adherer" effect, whereby adherence to drug therapy may be a surrogate marker for overall healthy behaviour.
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“In addition, as adherence with placebo also improves survival, 524 physicians should be aware that adherence to medication may reflect generally better health behaviour.”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [524]
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How is Patient Adherence Possible? A Novel Mechanistic Model of Adherence Based on Humanities
Reach, G. (2023) · Patient Preference and Adherence · doi:10.2147/ppa.s419277 · Cited by 14
“which data are available for patients in the placebo group, a strange effect is observed: mortality is lower in patients adherent to the placebo compared to their non-adherent counterparts.(91) This has led to the healthy adherer concept:”
BackgroundStatins use and risk of mortality in patient with Clostridium difficile infection
Saliba, W., Barnett‐Griness, O., Elias, M. S., & Rennert, G. (2014) · Clinical Microbiology and Infection · doi:10.1111/1469-0691.12672 · Cited by 12
“As patients who use statins for primary or secondary prevention are more likely to also seek other preventive services and to engage in healthy behaviours leading to a healthy user effect [19,20], measures were taken to correct for such a possible effect.”
BackgroundGonzález‐Juanatey, J. R., Mostaza, J. M., Lobos, J. M., Abarca, B., Llisterri, J. L., Barón‐Esquivias, G., Galve, E., Lidón, R. M., García–Moll, X., Sanchez, P. L., et al. (2016) · Medicina Clínica · doi:10.1016/j.medcli.2016.10.031 · Cited by 11
Achouri, M. Y., Mammeri, M., Sehanine, Y., Selka, M. A., Ghomari, W. I., Lahmer, A., & Habib, M. H. (2019) · Annales Pharmaceutiques Françaises · doi:10.1016/j.pharma.2019.08.003 · Cited by 12
Sulis, E., Amantea, I. A., Guido Boella, A., Marinello, R., Bianca, D., Brunetti, E., Bo, M., Bianco, A., Cattel, F., Cena, C., et al. (2019) · IEEE International Symposium on Consumer Electronics (ISCE) · doi:10.1109/isce.2019.8900989 · Cited by 12
“Consequently, adherence is the topic of uncountable studies [20-21].”
BackgroundMadae’en, S., Elayeh, E. R., Akour, A. A., Alqhaiwi, T., Shaggour, B., & Madain, R. (2020) · Journal of Applied Pharmaceutical Science · doi:10.7324/japs.2020.104007 · Cited by 12
“Results from different studies show that diabetic patients with good adherence to medications had positive health outcomes and lower mortality compared to those with poor adherence (Krapek et al., 2004; Rhee et al., 2005; Simpson et al., 2006) and that adherence to diabetes medications is considered substandard (Bries…”
BackgroundDesign of An IoT Based Smart Medicine Box
Adhikari, M. S., Khan, P. S., Senapathi, G., Chatterjee, B. P., Reddy, D. V., & Malik, P. K. (2023) · Devices for Integrated Circuit (DevIC) · doi:10.1109/devic57758.2023.10134884 · Cited by 12
“Every advantage and disadvantage of the living and non-living environment are intertwined, resulting in the emergence of numerous diseases or illnesses that endanger future generations of people [7]-[8].”
BackgroundImpact de la dépression sur l’adhésion aux traitements anticancéreux oraux
Chabrier, M., Bezy, O., Mouret‐Reynier, M., Bay, J., & Jalenques, I. (2013) · Bulletin du Cancer · doi:10.1684/bdc.2013.1824 · Cited by 13
How do Compliance, Convenience, and Tolerability Affect Blood Pressure Goal Rates?
Erdine, S. E. (2012) · American Journal of Cardiovascular Drugs · doi:10.1007/bf03261838 · Cited by 13
“(b) Association between good compliance (adherence), measured by selfreport, electronic drug event monitoring system, pharmacy refill data, clinician estimation, or tablet count, and all-cause mortality.([23]) CI= confidence interval.”
Márk, L., Paragh, G., Karádi, I., Reiber, I., Pados, G., & Kiss, Z. (2012) · Archives of Medical Science · doi:10.5114/aoms.2012.30283 · Cited by 12
“A series of studies has proven a linear correlation between patients’ adherence to lipid lowering therapy and long-term survival or rate of clinical events [24-26].”
BackgroundLower Risk of Major Cardiovascular Events Associated with Adherence to Colesevelam HCI
Ye, X., Qian, C., Liu, J., & Peter, W. L. S. (2013) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1002/phar.1317 · Cited by 12
Wessol, J. L., Russell, C. L., & Cheng, A. (2017) · Journal of Neuroscience Nursing · doi:10.1097/jnn.0000000000000266 · Cited by 12
“Adherence to a medication regimen is key in preventing recurrent stroke events.(3) Medications are prescribed to treat modifiable stroke risk factors with the intent of reducing the risk of recurrent stroke.”
BackgroundDefining Exposure in Observational Studies Comparing Outcomes of Treatment Discontinuation
Krumme, A. A., Glynn, R. J., Schneeweiß, S., Choudhry, N. K., Tong, A. Y., & Gagne, J. J. (2018) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.118.004684 · Cited by 12
Nieto, J. C., Aràjol, C., Carmona, L., Marras, C., & Cea‐Calvo, L. (2021) · Immunotherapy · doi:10.2217/imt-2021-0011 · Cited by 12
Association between multiple sclerosis disease severity and adherence to disease-modifying therapies
Burkhard, A., Toliver, J. C., & Rascati, K. L. (2021) · Journal of Managed Care & Specialty Pharmacy · doi:10.18553/jmcp.2021.27.7.915 · Cited by 12
Kogut, S. J., Johnson, S. J., Higgins, T., & Quilliam, B. J. (2012) · Journal of Managed Care Pharmacy · doi:10.18553/jmcp.2012.18.4.297 · Cited by 12
Calloch, R. L., Lacut, K., Gall‐Ianotto, C. L., Nowak, E., Abiven, M., Tempescul, A., Dalbiès, F., Eveillard, J., Ugo, V., Giraudier, S., et al. (2017) · Haematologica · doi:10.3324/haematol.2017.180448 · Cited by 12
“The importance of treatment compliance has now been clearly established in many pathological conditions, and especially in hematologic malignancies.(9,13-16) These studies typically demonstrate that poor adherence has a negative impact on clinical evolution.”
BackgroundCardiovascular Protection in Sleep Apnea: Is it a Question of CPAP Adherence?
Bailly, S., Trzépizur, W., & Gagnadoux, F. (2022) · Archivos de Bronconeumología · doi:10.1016/j.arbres.2022.11.001 · Cited by 12
Remondi, F. A., Cabrera, M. A. S., & de Souza, R. K. T. (2014) · PubMed · doi:10.1590/0102-311x00092613 · Cited by 11
Sheils, E., Tillett, W. L., James, D. H., Brown, S. L., Dack, C., Family, H. E., & Chapman, S. (2023) · Health Psychology · doi:10.1037/hea0001316 · Cited by 13
Bottacin, W. E., Luquetta, A., Gomes-Jr, L., de Souza, T. T., Reis, W. C. T., & Melchiors, A. C. (2024) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-024-01803-0 · Cited by 11
“Adherence to pharmacotherapy is a crucial factor for the success of treatment, and its absence can lead to harm to patients, death, increased use of health resources, and higher costs [1–3].”
Sacchetti, E., & Vita, A. (2013) · Springer eBooks · doi:10.1007/978-88-470-2679-7_1 · Cited by 11
Metadata
- Authors
- Simpson, S. H., Eurich, D. T., Majumdar, S. R., Padwal, R. S., Tsuyuki, R. T., Varney, J., & Johnson, J. A.
- Affiliations
- University of Alberta (CA)
- Institute of Health Economics (CA)
- Corresponding author
- Simpson, Scot H
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2006-06-21
- Volume
- 333
- Issue
- 7557
- Pages
- 15
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC1488752
- OpenAlex
- W2147982456
- Cited by
- 1,353
- References
- 39
- Citations by year
- 2026: 37 · 2025: 40 · 2024: 57 · 2023: 56 · 2022: 55 · 2021: 83 · 2020: 55 · 2019: 74 · 2018: 90 · 2017: 91 · 2016: 69 · 2015: 71 · 2014: 83 · 2013: 77 · 2012: 86
- FWCI
- 8.08
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Health Professions › Pharmacy › Pharmacy and Medical Practices
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- medication adherence, pharmacotherapy, mortality, adherence measurement methods
- MeSH terms
- Drug Therapy, Epidemiologic Methods, Humans, Patient Compliance, Prognosis, Randomized Controlled Trials as Topic
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