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The dynamics of chronic gout treatment: medication gaps and return to therapy.
Am J Med. 2010 Jan; 123(1):54-9.AJ

Abstract

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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Authors+Show Affiliations

Harrold LR
Meyers Primary Care Institute, Worcester, Mass., USA. leslie.harrold@umassmed.edu
Andrade SE
No affiliation info available
Briesacher B
No affiliation info available
Raebel MA
No affiliation info available
Fouayzi H
No affiliation info available
Yood RA
No affiliation info available
Ockene IS
No affiliation info available

MeSH

Age FactorsAgedAllopurinolAnti-Inflammatory Agents, Non-SteroidalChi-Square DistributionChronic DiseaseCohort StudiesColchicineDose-Response Relationship, DrugDrug Administration ScheduleFemaleFollow-Up StudiesGlucocorticoidsGoutGout SuppressantsHumansKaplan-Meier EstimateMaleMiddle AgedPatient ComplianceProbabilityProportional Hazards ModelsRisk AssessmentSeverity of Illness IndexSex FactorsTime FactorsTreatment OutcomeUric Acid

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

20102992

Citation

Harrold, Leslie R., et al. "The Dynamics of Chronic Gout Treatment: Medication Gaps and Return to Therapy." The American Journal of Medicine, vol. 123, no. 1, 2010, pp. 54-9.
Harrold LR, Andrade SE, Briesacher B, et al. The dynamics of chronic gout treatment: medication gaps and return to therapy. Am J Med. 2010;123(1):54-9.
Harrold, L. R., Andrade, S. E., Briesacher, B., Raebel, M. A., Fouayzi, H., Yood, R. A., & Ockene, I. S. (2010). The dynamics of chronic gout treatment: medication gaps and return to therapy. The American Journal of Medicine, 123(1), 54-9. https://doi.org/10.1016/j.amjmed.2009.05.026
Harrold LR, et al. The Dynamics of Chronic Gout Treatment: Medication Gaps and Return to Therapy. Am J Med. 2010;123(1):54-9. PubMed PMID: 20102992.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The dynamics of chronic gout treatment: medication gaps and return to therapy. AU - Harrold,Leslie R, AU - Andrade,Susan E, AU - Briesacher,Becky, AU - Raebel,Marsha A, AU - Fouayzi,Hassan, AU - Yood,Robert A, AU - Ockene,Ira S, PY - 2009/04/30/received PY - 2009/05/20/revised PY - 2009/05/20/accepted PY - 2010/1/28/entrez PY - 2010/1/28/pubmed PY - 2010/3/3/medline SP - 54 EP - 9 JF - The American journal of medicine JO - Am J Med VL - 123 IS - 1 N2 - 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. SN - 1555-7162 UR - https://www.unboundmedicine.com/medline/citation/20102992/The_dynamics_of_chronic_gout_treatment:_medication_gaps_and_return_to_therapy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9343(09)00710-4 DB - PRIME DP - Unbound Medicine ER -