High Rate of Adherence to Urate-Lowering Treatment in Patients with Gout: Who’s to Blame?

Abstract

Introduction Gout is commonly associated with low adherence rates, thus limiting the effectiveness of treatment. Nevertheless, informed and empowered patients may be more likely to achieve high adherence. We intend to demonstrate that adherence in clinical practice may reach that achieved in clinical trials. Methods This was a transversal study within an inception cohort of patients with gout prospectively followed up. Patients were informed at entrance in the cohort of outcomes, targets, and means to implement for successful treatment. Adherence was evaluated through electronic medication possession ratio (MPR) for urate-lowering medication and oral medications for hypertension, diabetes, and hyperlipidemia for comparison. Factors associated with nonadherence, and the relation between nonadherence and serum urate levels while on treatment were analyzed. Results Data were retrieved from 336 patients, who showed a mean MPR of 87.5%, with 82.1% of patients showing MPR ≥ 0.8. Rates of adherence for hypertension, hyperlipidemia, and diabetes were quite similar (88%, 87%, and 83%, respectively), although MPR > 0.8 was significantly lower for oral medications for diabetes. Adherence was lower, but nevertheless quite fair, during the first year of follow-up, and increasing over time. Active follow-up and comorbidity were associated with good adherence, and adherence and long-term follow-up were associated with higher rates of achieving serum urate within therapeutic target. Conclusion Patients with gout show high rates of adherence if empowered. Active follow-up and comorbidity are associated with high rates of adherence. Adherence is strongly associated with higher rates of achievement of therapeutic serum urate target.

Changes in Prescription Drug and Health Care Use Over 9 Years After the Large Drug Price Increase for Colchicine

“…One key hypothesis was that when the price of a therapeutic treatment rises substantially, patients and clinicians may increase their focus on prevention, which may be a beneficial outcome. Allopurinol is considered the first-line medication for prevention of recurrent gout flares, tophi, and disease progression . When the patient experiences a gout flare, colchicine or oral corticosteroids may be used to treat the flare.…”

Towards a more ambitious uricemia target to improve joint and cardiovascular outcomes in gout

“…At this point we must emphasize the need to also include other non-pharmacological strategies in the holistic management of CVR in gout patients, promoting a healthy lifestyle and controlling comorbidities such as chronic kidney disease or metabolic syndrome, both closely related to hyperuricemia and gout. We also strongly support active follow-up, patient empowerment, and nurse/pharmacist-led interventions to improve adherence to ULT and follow-up, as well as reduce/avoid taking non-steroidal anti-inflammatory drugs (NSAIDs), thus helping to achieve analytical and clinical goals (Figure 1) [30]. In conclusion, we suggest SUA < 5 mg/dL as a more ambitious target within the treat-to-target approach for the management of gout in order to achieve better joint and cardiovascular outcomes in patients with CVR or severe disease.…”