Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Mar;42(3):504-12.
doi: 10.3899/jrheum.140588. Epub 2014 Dec 15.

Modifiable factors associated with allopurinol adherence and outcomes among patients with gout in an integrated healthcare system

Nazia Rashid  1 , Brian W Coburn  2 , Yi-Lin Wu  2 , T Craig Cheetham  2 , Jeffrey R Curtis  2 , Kenneth G Saag  2 , Ted R Mikuls  2
Affiliations

Modifiable factors associated with allopurinol adherence and outcomes among patients with gout in an integrated healthcare system

Nazia Rashid et al. J Rheumatol. 2015 Mar.

Abstract

Objective: To identify modifiable patient and provider factors associated with allopurinol adherence and the achievement of a serum urate acid (SUA) goal in gout.

Methods: We identified a retrospective cohort of patients with gout, newly treated with allopurinol. All patient data came from administrative datasets at a large integrated health delivery system. Patients were ≥ 18 years old at time of initial allopurinol dispensing, and had 12 months or more of membership and drug eligibility prior to the index date. Allopurinol adherence was defined as a proportion of days covered ≥ 0.80, evaluated during the first 12 months of observation after the initial dispensing. Multivariable logistic regression was used to examine factors associated with allopurinol nonadherence and attaining an SUA concentration < 6.0 mg/dl.

Results: We identified 13,341 patients with gout with incident allopurinol use (mean age 60 yrs, 78% men). Of these, 9581 patients (72%) had SUA measured both at baseline and during followup. Only 3078 patients (32%) attained an SUA target of < 6.0 mg/dl during followup. Potentially modifiable factors associated with treatment adherence and obtaining the SUA goal in the multivariable analysis included concomitant diuretic use, prescriber specialty, and allopurinol dosing practices. Adherent patients were 2.5-fold more likely than nonadherent patients to achieve an SUA < 6.0 mg/dl during observation.

Conclusion: Among patients with gout initiating allopurinol in our study, 68% did not reach the SUA goal and 57% of patients were nonadherent. Modifiable factors, including allopurinol dose escalation, treatment adherence, rheumatology referral, and concomitant medication use, could be important factors to consider in efforts aimed at optimizing gout treatment outcomes.

Keywords: ADHERENCE; ALLOPURINOL; GOUT; INCIDENT.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Sample Selection Flowchart
See this image and copyright information in PMC

References

    1. Becker M, Schumacher H, Wortmann R, MacDonald P, Eustace D, Palo W, et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med. 2005;353:2450–61. - PubMed
    1. Schumacher H, Becker M, Wortmann R, Macdonald P, Hunt B, Streit J, et al. Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout: A 28-week, phase III, randomized, double-blind, parallel-group trial. Arthritis Rheum. 2008;59:1540–8. - PubMed
    1. Becker M, Schumacher H, Espinoza L, Wells A, MacDonald P, Lloyd E, et al. The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout: The CONFIRMS trial. Arthritis Res Ther. 2010:12. - PMC - PubMed
    1. Sundy J, Baraf H, Yood R, Edwards N, Gutierrez-Urena S, Treadwell E, et al. Efficacy and tolerability of pegloticase for the treatment of chronic gout in patients refractory to conventional treatment: Two randomized controlled trials. JAMA. 2011;306:711–20. - PubMed
    1. Zhang W, Doherty M, Bardin T, Pascual E, Barskova V, Conaghan P, et al. EULAR evidence based recommendations for gout. part II: Management. report of a task force of the EULAR standing committee for international clinical studies including therapeutics (ESCISIT). Ann Rheum Dis. 2006;65:1312–24. - PMC - PubMed

Publication types