The Dynamics of Chronic Gout Treatment: Medication Gaps and Return to Therapy

Meyers Primary Care Institute, Worcester, Mass., USA.
The American journal of medicine (Impact Factor: 5). 01/2010; 123(1):54-9. DOI: 10.1016/j.amjmed.2009.05.026
Source: PubMed


To identify gaps in therapy with urate-lowering drugs for the treatment of gout as well as factors associated with resuming therapy.
From 2 integrated delivery systems, we identified patients 18 years or older with a diagnosis of gout who initiated use of a urate-lowering drug from January 1, 2000 through June 30, 2006 and who had a gap in therapy. A gap was defined as a period of over 60 days after the completion of 1 prescription in which no refill for a urate-lowering drug was obtained. Survival curves were used to assess return to therapy of urate-lowering drugs. Cox proportional hazards analysis estimated the association between covariates and return to therapy.
There were 4166 new users of urate-lowering drugs (97% received allopurinol), of whom 2929 (70%) had a gap in therapy. Among those with a gap, in 75% it occurred in the first year of therapy. Fifty percent of patients with a gap returned to therapy within 8 months, and by 4 years it was 75%. Age 45-74 years (<45 referent) and greater duration of urate-lowering drug use before the gap was associated with resuming treatment within 1 year. In contrast, receipt of nonsteroidal anti-inflammatory drugs or glucocorticoids in the year before the gap was associated with a reduced likelihood of resuming therapy.
The majority of gout patients with gaps in urate-lowering drug use returned to treatment. More investigation is needed to better understand why patients may go for months without refilling prescriptions, given the clinical consequences of nonadherence.

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Available from: Marsha A Raebel, Feb 06, 2014
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    • "In this study, lack of awareness regarding the need for chronic therapy with urate-lowering medications as well as short-term risk of acute gout symptoms with initiation of this class of medications may help explain the results of larger epidemiologic studies, specifically that most patients who initiate a urate-lowering medication have large gaps in drug use over the first year [14-17] with most returning to treatment over the next 4 years [27]. While interruptions in medication drug use commonly occur due to financial concerns or side effects, it is less likely these factors played a role given the availability of generic medications with modest copayments and that most patients eventually restarted their prior urate-lowering medication. "
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