Journal List > J Korean Rheum Assoc > v.17(2) > 1003717

TOOLS
Son, Seo, Kim, Bae, Jung, Cha, and Kim: Adherence to Uric Acid Lowering Agent of Gouty Patients
Original Article

J Korean Rheum Assoc 2010;17(2):162-167.

Published online: 23 June 2010

DOI: https://doi.org/10.4078/jkra.2010.17.2.162

Adherence to Uric Acid Lowering Agent of Gouty Patients

Kyeong Min Son, Young-H Seo, In Je Kim, Young Deok Bae, Young Ok Jung, Myeong Jin Cha, Hyun Ah Kim

Department of Internal Medicine, Hallym University College of Medicine, Chunchun, Korea

Received 18 March 201024 May 2010       Accepted 31 May 2010

Copyright © 2010 The Korean Rheumatism Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

Gout is crystal-induced arthritis with hyperuricemia. Uric acid lowering agent (UALA) is the maintenance drug of its treatment. Drug adherence is an important factor that influences treatment outcome. The purpose this study was to examine the drug adherence to UALA of 303 gouty patients and to analyze the factors associated with compliance.

Methods

We retrospectively assessed adherence to UALA in 303 patients who visited three hospitals affiliated with Hallym University. Patients were diagnosed as gout and used UALA with at least 6 month follow-up. Two adherence measures were calculated, the percentage of days covered (PDC) and the time until an extended break (at least 60 days) in treatment. A PDC < 70% was considered poor adherence and factors associated with poor adherence were examined.

Results

Among the 303 patients, 283 (93.4%) were male. Mean age was 55.4±13.7 years. Comorbidities included hypertension in 117 (38.6%), diabetic mellitus in 108 (35.6%), angina in 107 (35.3%), myocardial infarction in 108 (35.6%), and heart failure in 113 (37.3%). The mean PDC was 65.8% with 63.4% of patients considered poorly compliant over the study period. Mean treatment duration before an extended break occurred was 203.5 days. Factors associated with good adherence included hypertension and prescription from rheumatologist.

Conclusion

In our study, adherence to UALA in gouty patient was poor. Understanding the factors associated with adherence to UALA and proper education of gouty patients to improve drug adherence are needed.

Keywords: Gout, Uric acid, Adherence

REFERENCES

1). Riedel AA., Nelson M., Joseph-Ridge N., Wallace K., MacDonald P., Becker M. Compliance with allopurinol therapy among managed care enrollees with gout: a retrospective analysis of administrative claims. J Rheumatol. 2004. 31:1575–81.
2). Solomon DH., Avorn J., Levin R., Brookhart MA. Uric aid lowering therapy: prescribing patterns in a large cohort of older adults. Ann Rheum Dis. 2008. 67:609–13.
3). Harrold LR., Andrade SE., Briesacher BA., Raebel MA., Fouayzi H., Yood RA, et al. Adherence with uratelowering therapies for the treatment of gout. Arthritis Res Ther. 2009. 11:R46.
crossref
4). Burnier M. Long-term compliance with antihypertensive therapy: another facet of chronotherapeutics in hypertension. Blood Press Monit. 2000. ;5 Suppl. 3:31. S.
5). Cantrell CR., Eaddy MT., Shah MB., Regan TS., Sokol MC. Methods for evaluating patient adherence to antidepressant therapy: a real-world comparison of adherence and economic outcomes. Med Care. 2006. 44:300–3.
6). Benner JS., Glynn RJ., Mogun H., Neumann PJ., Weinstein MC., Avorn J. Long-term persistence in use of statin therapy in elderly patients. JAMA. 2002. 288:455–61.
crossref
7). Park CY., Yim J., Kang IO., Im J. The health behavior and medication compliance of patients with hypertension and diabetes mellitus. Health Insurance Forum. 2007. 6:111–21.
8). Kim GY., Park JB., Kim BW. Short-term glycemic control and the related factor in associated with compliance in diabetic patient. J Prev Med Public Health. 2000. 33:347–63.
9). Harrold LR., Andrade SE., Briesacher B., Raebel MA., Fouayzi H., Yood RA, et al. The dynamics of chronic gout treatment: medication gaps and return to therapy. Am J Med. 2010. 123:54–9.
crossref

Table 1.
Baseline characteristics of patients
Male (N, %) 283 (93.4)
Age (year) 55.4+13.7
Comorbidity (N, %)
Hypertension 117 (38.6)
Diabetic mellitus 108 (35.6)
Angina 107 (35.3)
Myocardial infarction 108 (35.6)
Heart failure 113 (37.3)
Diagnosed as gout previously (N, %) 206 (68.0)
Number of concomitant medication 5.8±3.1

Data are expressed as mean±SD unless specified otherwise

Table 2.
Characteristics related to gout treatment
Number of physician visits, any cause 34.6±39.3
Number of physician visits, gout 17.9±15.7
Starting dosage of allopurinol (mg) 144.2±64.3
Pre-treatment uric acid level (mg/dL) 8.6±2.2
Post-treatment uric acid level (mg/dL) 7.0±2.0
Mean percentage of days covered (PDC) 65
PDC >70% (N, %) 111 (36.6)
Time until a break >60 days in allopurinol (days) 203.5±132.4

Data are expressed as mean±SD unless specified otherwise

Table 3.
Factors associated with good compliance
Good compliance (N=111) Poor compliance (N=192) p-value
Male 101 (91.0) 182 (94.8) 0.199
Age 0.560
20~39 45 (40.5) 70 (36.5)
40~59 45 (40.5) 90 (46.9)
>60 21 (18.9) 32 (16.7)
Hypertension 51 (47.7) 66 (34.7) 0.029∗
Diabetic Mellitus 22 (20.8) 86 (45.7) <0.001∗
Angina 17 (17.9) 90 (50.8) <0.001∗
Myocardial infarction 17 (18.3) 91 (51.7) <0.001∗
Heart failure 23 (24.2) 90 (51.1) <0.001∗
Diagnosed as gout previously 64 (62.7) 142 (78.0) 0.006∗
Prescription from rheumatologist 94 (86.2) 125 (65.8) <0.001∗

By Chi-square test, ∗p-value: statistically significant p-value

Table 4.
Adjusted logistic regression model for adherence; variables associated with less than 70% of days covered
Variable Crude odds ratio Adjusted odds ratio (95% confidence interval) p-value
Gender (female) 1.80 (0.73~4.48) 2.29 (0.73~7.20) 0.155
Age
20~39 0.98 (0.50~1.90) 0.89 (0.38~2.06) 0.780
40~59 0.76 (0.40~1.47) 0.66 (0.29~1.52) 0.329
>60 1 1
Hypertension 1.71 (1.06~2.77) 2.98 (1.59~5.60) 0.001∗
Diabetic Mellitus 0.31 (0.18~0.54) 0.60 (0.26~1.40) 0.239
Myocardial infarction 0.20 (0.11~0.38) 0.29 (0.13~0.66) 0.003∗
Prescription from rheumatologist 3.26 (1.75~6.07) 2.25 (1.02~4.98) 0.045∗
Diagnosed as gout previously 0.47 (0.28~0.80) 0.72 (0.38~1.37) 0.311

Variables considered for the multivariable models included age, sex, underlying disease (hypertension, diabetic mellitus, myocardial infarction), diagnosed as gout previously, prescription from rheumatologist. Reference groups are as follows: male gender, age >60, no underlying disease (hypertension, diabetic mellitus, myocardial infarction), first diagnosed as gout), prescription from non-rheumatologist. ∗p-value: statistically significant p-value

TOOLS
Similar articles