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Urate lowering therapy can be very effective for reducing flares of gout, thereby preventing ongoing joint damage and deformity. Despite this efficacy, most gout patients are undertreated, leading to undue painful flares and joint damage. Non-adherence to therapy is a strong contributor to undertreatment. Here, Solomon et al (Ann Rheum Dis 2008; 67: 609) explore adherence to and barriers to urate lowering therapy in a cohort of patients receiving urate lowering therapy through a state supported pharmacy benefit program.
Abstract
Background: Uric acid lowering therapy (UALT) is considered a chronic treatment for gout. Relatively little is known about adherence to UALT.
Methods: We assessed adherence with UALT over a 1-year study period among 9823 older adults enrolled in a pharmacy benefit program. Two adherence measures were calculated, the percentage of days covered (PDC) and the time until an extended break (at least 60 days) in treatment. A PDC <80% was considered poor adherence and its predictors were examined in multivariable logistic models.
Results: The mean (SD) PDC was 54% (36%) with 64% of patients considered poorly compliant over the study period. A total of 56% had experienced an extended break in UALT. Predictors of poor adherence included younger age (odds ratio (OR) 1.50, 95% CI 1.33?1.69 for ages 65?74 compared with 85 and above) and African?American race (OR 1.86, 95% CI 1.52?2.27 compared with Caucasian race). Most patients (93%) received their initial UALT prescription from a non-specialist and this also predicted poor adherence (OR 1.15, 95% CI 0.96?1.38 compared with rheumatologists or nephrologists).
Conclusion Adherence with UALT is poor. While uric acid levels were not measured in this study, poor adherence with UALT is likely to reduce attainment of goal uric acid levels.
