Adherence to Gout Therapies Painfully Low Save

There are numerous, highly effective urate-lowering therapies (ULT) to treat and prevent gout attacks, yet gout remains the most common undertreated and poorly treated form of arthritis.  While some of this responsibility lies with healthcare providers, patient factors may color the outcomes.

A retrospective study of the large UK Clinical Practice Research Datalink (1987–2014) sought to assess patient medication compliance in gout and found that adherence to allopurinol in gout is poor, especially among females and younger patients and those with fewer comorbidities. 

They examined newly diagnosed gout patients, ⩾40 years and starting allopurinol (n = 48 280). Non-persistence was measured as amedication gap of ⩾90 days after 1 and 5 years. Non-adherence identified patients whose complied with treatment <80% over the observation period. 

From year 1 to year 5, non-persistence increased from 38.5% to 56.9% after allopurinol initiation. After a first gap in therapy, 43.3% restarted allopurinol therapy within 1 year. Yet again only 52.3% persisted for 1 year.

Non-persistence and non-adherence were higher in females, current smokers.  Persistence and adherence were higher in older and overweight gout patients, those on anti-hypertensives or colchicine and those with comorbidities (dementia, diabetes or dyslipidemia). 

Another metanalysis of 24 studies similarly showed that ULT adherence was less than 48% and  that non-persistence ranged from 54% to 87%. In some of these studies, adherence positively correlated with older age, more comorbidities, and the presence of diabetes or hypertension. (Citation source: http://bit.ly/2wtjN1f)