title: Subject retention and adherence in a randomized placebo-controlled trial of a disease-modifying osteoarthritis drug.
abstract: OBJECTIVE
  To describe the methods by which remarkable levels of subject retention and adherence were achieved in a 30-month multicenter randomized placebo-controlled trial (RCT) of a disease-modifying osteoarthritis drug (DMOAD).
  
  
  METHODS
  Subjects were obese 45-64-year-old women with unilateral knee osteoarthritis. Before randomization, each volunteer completed a 4-week "faintness-of-heart" (FOH) test, during which she was required to demonstrate reliable appointment keeping and > or =80% adherence to the dosing regimen. Subjects who passed the FOH test were randomized to treatment with doxycycline or placebo for 30 months. The double-blind phase entailed 15 bimonthly followup visits; intervisit adherence data were downloaded from the dosing monitor and used to estimate therapeutic coverage and to identify correctable patterns of nonadherence. Subjects received token incentives and a small cash payment at each followup visit. Measures to prevent or treat side effects of doxycycline were dispensed free of charge. Study coordinators monitored safety and reinforced participation through between-visit telephone calls.
  
  
  RESULTS
  Of 463 eligible volunteers, 32 (7%) failed the FOH test and were excluded from the double-blind phase. Among the 431 subjects randomized to treatment groups, 307 (71%) completed the 30-month RCT and 124 discontinued the study drug prematurely. Nearly half of the dropouts returned for their 16- and 30-month radiographs, resulting in loss to followup of 14.8% of randomized subjects. The 2 treatment groups did not differ significantly with respect to rates of discontinuation or retention. Therapeutic coverage over 30 months was very high in both groups.
  
  
  CONCLUSIONS
  The rate of discontinuation in this 30-month RCT (29%) was lower than that of any DMOAD trial of > or =2 years duration published to date. The proportion of subjects for whom 30-month radiographs were available (85%) and adherence to the dosing regimen (mean >80%) also were remarkably high.
authors.affiliation: Indiana University School of Medicine, Indianapolis, 46202-5100, USA. smazzuca@iupui.edu
authors.forename: Steven A
authors.initials: SA
authors.lastname: Mazzuca
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Brandt
authors.forename: Barry P
authors.initials: BP
authors.lastname: Katz
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Lane
authors.forename: John D
authors.initials: JD
authors.lastname: Bradley
authors.forename: Louis W
authors.initials: LW
authors.lastname: Heck
authors.forename: Steven T
authors.initials: ST
authors.lastname: Hugenberg
authors.forename: Susan
authors.initials: S
authors.lastname: Manzi
authors.forename: Larry W
authors.initials: LW
authors.lastname: Moreland
authors.forename: Chester V
authors.initials: CV
authors.lastname: Oddis
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Schnitzer
authors.forename: Leena
authors.initials: L
authors.lastname: Sharma
authors.forename: Frederick
authors.initials: F
authors.lastname: Wolfe
authors.forename: David E
authors.initials: DE
authors.lastname: Yocum
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D004311:Double-Blind Method; D004318:Doxycycline / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000188:drug therapy*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic / Q000379:methods*
chemical_list: D018501:Antirheumatic Agents; D004318:Doxycycline