Adherence and persistence to urate-lowering therapies in the Irish setting

Abstract

To identify adherence and persistence levels with urate-lowering therapies using the national administrative pharmacy claim database. This was a retrospective, pharmacy claims-based analysis of dispensed anti-gout medications on the Irish national HSE-PCRS scheme database between January 2008 and December 2012. Adherence is defined by the medication possession ratio (MPR), and patients were considered to be adherent if the MPR ≥80 % (good adherers) in any given time period. Persistence was defined as continued use of therapy with no periods exceeding a refill gap of >63 days (9 weeks). Logistic regression analysis was used to predict odd ratios (OR) and 95 % confidence interval (CI) for persistence and adherence in relation to age, gender and level of comorbidity. There was a 53 % increase in the number of patients prescribed anti-gout medications between 2008 and 2012 with an increase of 27 % in the associated ingredient cost of these medications. Allopurinol accounted for 87 % of the prescribing and febuxostat accounted for a further 9 %. In patients who started on 100 mg allopurinol, only 14.6 % were titrated to the 300 mg dose. For all those initiating urate-lowering therapies, 45.8 % of patients were persistent with treatment at 6 months decreasing to 22.6 % at 12 months. In multivariate analysis, females had poorer adherence (OR = 0.83 (0.77-0.90)), and increasing age was associated with increased adherence (OR = 4.19 (2.53-6.15)) Increasing comorbidity score was associated with increased adherence and persistence at 6 months (OR = 0.68 (0.59-0.79)). Adherence with anti-gout medications in this study cohort was relatively low. Sustained treatment for gouty arthritis is essential in the prevention of serious adverse outcomes.Significance and Innovations-Poor adherence to medications prescribed to patients for the management of chronic diseases such as gout is an ongoing problem which urgently needs to be addressed.-Some of the reasons identified for poor adherence to anti-gout medications include the risk of flare of acute gout with the initiation of urate-lowering therapy (ULT), poor response to ULT and persistence of attacks of acute gout, suboptimal dosing of allopurinol therapy and intolerance of allopurinol.-The results of this study identified adherence and persistence rates of approximately 50 % at 6 months which is in line if not lower than many of the other published studies to date which have measured adherence and persistence using pharmacy claims databases.-The results of poor adherence and persistence affect both the health of the patients with financial implications for the healthcare service.

A retrospective analysis of medication prescription records for determining the levels of compliance and persistence to urate-lowering therapy for the treatment of gout and hyperuricemia in The Netherlands

“…After 1 year, only 42.7% of the patients were still getting their prescriptions refilled, and 51.7% of the patients had ULT medication coverage of at least 80% of the study days. These findings further substantiate previous reports where suboptimal medication adherence to ULT has been highlighted as a concern in gout patients, in various healthcare systems [6, 13–15]. In fact, an earlier report from Germany and the United Kingdom described similar discouraging results [16].…”

Predictors of reaching a serum uric acid goal in patients with gout and treated with febuxostat

“…Adherence to febuxostat showed a positive relationship with uric acid levels in patients who attained sUA goal <6 mg/dL as well as the more stringent goal sUA <5 mg/dL. Although low compliance with allopurinol has been reported (average noncompliance of 44% of their treatment period), 15 , 17 , 18 the effect of compliance on attaining sUA goal has not been studied among these patients, 19 restricting comparisons with febuxostat users.…”

Treat-to-target (T2T) recommendations for gout

“…Given the low adherence to medication by patients with gout, strategy trials, in which therapeutic adjustments are made according to a prespecified timeline and/or prespecified endpoints, should address this critical issue. Presumably, strategy trials will be able to include an adequate approach to control for non-adherence 54. A treatment strategy study will be important to improve the management of patients with gout and should be initiated in the near future.…”