Gout Medication Treatment Patterns and Adherence to Standards of Care From a Managed Care Perspective

Sarawate, Chaitanya; Brewer, Kathleen; Yang, Wenya; Patel, Pankaj; Schumacher, H. Ralph; Saag, Kenneth G.; Bakst, Alan

doi:10.4065/81.7.925

Cited by 270 publications

(233 citation statements)

References 10 publications

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“…Importantly, this possibility suggests that our estimate of SU goal knowledge, although quite low, is likely higher than would be seen in a broader patient population. Our study also indicated high levels of medication adherence for both questionnaire responders and nonresponders relative to other recent studies (15,(37)(38)(39)(40)(41). The PDC values in our study are higher than in other studies, likely due to the high proportion of prevalent users in our cohort and the use of mailed prescriptions in the VA system.…”

Section: Discussionsupporting

confidence: 60%

Target Serum Urate: Do Gout Patients Know Their Goal?

Coburn

Bendlin

Sayles

et al. 2016

Arthritis Care & Research

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Objective. To examine gout patients' knowledge of their condition, including the central role of achieving and maintaining the serum urate (SU) goal with the use of urate-lowering therapy (ULT).Methods. This study of 612 gout patients was conducted at a Veterans Affairs medical center. Gout patients were included based on administrative diagnostic codes and receipt of at least 1 allopurinol prescription over a 1-year period. Questionnaires were mailed to patients and linked to medical records data. The questionnaire included goutspecific knowledge questions, the Patient Activation Measure, and self-reported health outcomes. Knowledge was assessed descriptively. Multivariable logistic regression was used to determine predictors of SU goal knowledge. Associations of knowledge with health outcomes were examined in exploratory analyses. Results. The questionnaire had a 62% response rate. Only 14% of patients knew their SU goal, while the majority answered correctly for the other 5 gout-specific knowledge questions. In adjusted analyses, having a rheumatologist as initial prescriber (odds ratio [OR] 3.0 [95% confidence interval (95% CI) 1.4-6.2]) and knowing all of the other 5 gout-specific knowledge questions (OR 2.1 [95% CI 1.3-3.4]) were associated with greater odds of knowing the SU goal. SU goal knowledge was associated with self-reported global health status, but not with self-reported health-related quality of life or gout-specific health status. Conclusion. There is a knowledge deficit regarding the SU treatment goal among gout patients receiving ULT, despite generally high levels of other gout-specific knowledge. SU goal information may be an important and underutilized concept among providers treating gout patients.

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Section: Discussionsupporting

confidence: 60%

Target Serum Urate: Do Gout Patients Know Their Goal?

Coburn

Bendlin

Sayles

et al. 2016

Arthritis Care & Research

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“…Using a managed care database, Sarawate and colleagues found that approximately 26% percent of 2405 allopurinol users over a two-year period had a medication possession ratio of ≥ 80% (actual days supply received divided by the maximum possible medication supply) and the median length of continuous treatment was only three months. 30 Riedel and coworkers similarly used an administrative dataset to examine adherence with allopurinol over a 24 month period. 7 Among 5597 patients who filled at least 2 prescriptions for allopurinol, only 18% were adherent with therapy (≥ 0.80).…”

Section: Adherence Resultsmentioning

confidence: 99%

Medication Adherence of Patients with Selected Rheumatic Conditions: A Systematic Review of the Literature

Harrold

Andrade

2009

Seminars in Arthritis and Rheumatism

106

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Objective-Nonadherence with medication treatment has been found to occur in large proportions of patients with a broad range of chronic conditions. Our aim was to perform a systematic review of the literature examining adherence with treatments for inflammatory rheumatic conditions to assess the magnitude of the problem in this patient population.Methods-A MEDLINE search of English language literature was performed to identify studies published between January 1, 1985 and November 30, 2007 that evaluated adherence with chronic medications needed in the treatment of rheumatic conditions.Results-A total of 20 articles met the criteria for evaluation, the majority of which focused on the treatment of rheumatoid arthritis. Most of the studies examined the use of nonsteroidal antiinflammatory medications and disease modifying anti-rheumatic drugs. Adherence was assessed based on self-report, pill counts, pharmacy dispensings, openings of pill containers using electronic devices, laboratory assays, and physician assessment. Adherence varied greatly based on the adherence measure used, arthritic condition evaluated and medication under study. Overall, the highest rates of adherence were based on self-reports for a wide variety of medications and conditions (range of persons reporting adherence was 30 to 99%), while the lowest adherence rates were for allopurinol based on pharmacy dispensings (18-26%).Conclusions-Adherence has not been widely examined for most chronic inflammatory rheumatic conditions and the few studies that exist used different definitions and populations, thus limiting any conclusions. However, the current literature does suggest that nonadherence is a substantial problem.

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“…It is likely that gout flares occurring during initiation with ULT may contribute to this poor adherence (13,41). Studies indicate that up to 50% of patients discontinue ULT within 3 months of initiation (13,41), resulting in continued hyperuricemia that contributes to poor disease control (13) and also possibly to increased cardiovascular risk (42). Since the therapeutic goal of gout management is maintaining low serum urate levels through long-term ULT adherence, reduction of initial ULT-associated flares may improve adherence.…”

Section: Discussionmentioning

confidence: 99%

Rilonacept (interleukin‐1 trap) for prevention of gout flares during initiation of uric acid–lowering therapy: Results from a phase III randomized, double‐blind, placebo‐controlled, confirmatory efficacy study

Schumacher¹,

Evans²,

Saag³

et al. 2012

Arthritis Care & Research

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Objective. To evaluate the efficacy and safety of the interleukin-1 inhibitor rilonacept (interleukin-1 Trap) for gout flare prevention during initiation of uric acid-lowering therapy (ULT). Methods. In total, 241 adult patients with gout, >2 gout flares within the past year, and a serum urate level >7.5 mg/dl were initiated on allopurinol 300 mg daily and randomly allocated in a 1:1:1 ratio to receive 16 once-weekly subcutaneous injections of placebo, rilonacept 80 mg, or rilonacept 160 mg, with a double (loading) dose on day 1. Allopurinol was titrated to achieve a serum urate level of <6.0 mg/dl. The study was powered for the primary efficacy end point, the number of gout flares per patient through week 16.

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Gout Medication Treatment Patterns and Adherence to Standards of Care From a Managed Care Perspective

Cited by 270 publications

References 10 publications

Target Serum Urate: Do Gout Patients Know Their Goal?

Target Serum Urate: Do Gout Patients Know Their Goal?

Medication Adherence of Patients with Selected Rheumatic Conditions: A Systematic Review of the Literature

Rilonacept (interleukin‐1 trap) for prevention of gout flares during initiation of uric acid–lowering therapy: Results from a phase III randomized, double‐blind, placebo‐controlled, confirmatory efficacy study

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