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1st April 2009, 05:52 AM
Adherence with urate-lowering therapies for the treatment of gout.
Harrold LR, Andrade SE, Briesacher BA, Raebel MA, Fouayzi H, Yood RA, Ockene IS.
Arthritis Res Ther. 2009 Mar 27;11(2):R46. [Epub ahead of print] (http://arthritis-research.com/content/11/2/R46)
INTRODUCTION: Adherence to urate-lowering drugs has not been well evaluated among those with gout. Our aim was to assess the level and determinants of nonadherence with ULDs prescribed for gout.
METHODS: We identified persons from two integrated delivery systems 18 years or older with a diagnosis of gout who initiated use of allopurinol, probenecid, or sulfinpyrazone from January 1, 2000 through June 30, 2006. Nonadherence was measured using the medication possession ratio over the first year of therapy and defined as an MPR < 0.8. Descriptive statistics were calculated and logistic regression was used to estimate the strength of the association between patient characteristics and nonadherence.
RESULTS: There were 4,166 gout patients who initiated ULDs; 97% received allopurinol. Median MPR for any ULD use was 0.68 (interquartile range 0.64). Over half of the patients (56%) were nonadherent (MPR < 0.8). In adjusted analyses, predictors of poor adherence included younger age (OR 2.43, 95% CI 1.86 to 3.18 for ages <45 and OR 1.44, 95% CI 1.08 to 1.93 for ages 45 to 49), fewer comorbid conditions (OR 1.46, 95% CI 1.20 to 1.77), no provider visits for gout prior to urate-lowering drug initiation (OR 1.28, 95% CI 1.05 to 1.55), and use of non-steroidal anti-inflammatory drugs in the year prior to urate-lowering drug initiation (OR 1.15, 95% CI 1.00 to 1.31).
CONCLUSIONS: Nonadherence amongst gout patients initiating ULDs is exceedingly common, particularly in younger patients with less comorbidity and no provider visits for gout prior to ULD initiation. Providers should be aware of the magnitude of nonadherence with ULDs.
Harrold LR, Andrade SE, Briesacher BA, Raebel MA, Fouayzi H, Yood RA, Ockene IS.
Arthritis Res Ther. 2009 Mar 27;11(2):R46. [Epub ahead of print] (http://arthritis-research.com/content/11/2/R46)
INTRODUCTION: Adherence to urate-lowering drugs has not been well evaluated among those with gout. Our aim was to assess the level and determinants of nonadherence with ULDs prescribed for gout.
METHODS: We identified persons from two integrated delivery systems 18 years or older with a diagnosis of gout who initiated use of allopurinol, probenecid, or sulfinpyrazone from January 1, 2000 through June 30, 2006. Nonadherence was measured using the medication possession ratio over the first year of therapy and defined as an MPR < 0.8. Descriptive statistics were calculated and logistic regression was used to estimate the strength of the association between patient characteristics and nonadherence.
RESULTS: There were 4,166 gout patients who initiated ULDs; 97% received allopurinol. Median MPR for any ULD use was 0.68 (interquartile range 0.64). Over half of the patients (56%) were nonadherent (MPR < 0.8). In adjusted analyses, predictors of poor adherence included younger age (OR 2.43, 95% CI 1.86 to 3.18 for ages <45 and OR 1.44, 95% CI 1.08 to 1.93 for ages 45 to 49), fewer comorbid conditions (OR 1.46, 95% CI 1.20 to 1.77), no provider visits for gout prior to urate-lowering drug initiation (OR 1.28, 95% CI 1.05 to 1.55), and use of non-steroidal anti-inflammatory drugs in the year prior to urate-lowering drug initiation (OR 1.15, 95% CI 1.00 to 1.31).
CONCLUSIONS: Nonadherence amongst gout patients initiating ULDs is exceedingly common, particularly in younger patients with less comorbidity and no provider visits for gout prior to ULD initiation. Providers should be aware of the magnitude of nonadherence with ULDs.