The dynamics of chronic gout treatment: medication gaps and return to therapy
Meyers Primary Care Institute; Department of Medicine, Division of Rheumatology; Clinical and Population Health Research Program
Medical Subject Headings
Age Factors; Aged; Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Chi-Square Distribution; Chronic Disease; Cohort Studies; Colchicine; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Glucocorticoids; Gout; Gout Suppressants; Humans; Kaplan-Meiers Estimate; Male; Middle Aged; Patient Compliance; Probability; Proportional Hazards Models; Risk Assessment; Severity of Illness Index; Sex Factors; Time Factors; Treatment Outcome; Uric Acid
Health Services Research | Medicine and Health Sciences
OBJECTIVE: To identify gaps in therapy with urate-lowering drugs for the treatment of gout as well as factors associated with resuming therapy.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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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Citation: Am J Med. 2010 Jan;123(1):54-9. Link to article on publisher's site