Medication adherence among gout patients initiated allopurinol : a retrospective cohort study in the Clinical Practice Research Datalink (CPRD)
Objectives: When urate lowering therapy is indicated in patients with gout, medication adherence is essential. This study assesses non-persistence and non-adherence in patients with newly diagnosed gout, and identifies factors associated with poor medication adherence.
Methods: A retrospective data analysis was performed within the UK Clinical Practice Research Datalink (1987-2014) among incident gout patients, aged ⩾40 years and starting allopurinol (n = 48 280). The proportion of patients non-persistent (a first medication gap of ⩾90 days) after 1 and 5 years, and median time until a first 90-day gap was estimated using Kaplan-Meier statistics in those starting allopurinol and restarting after a first interruption. Non-adherence (proportion of days covered <80%) over the full observation period was calculated. Multivariable Cox- or logistic regressions assessed factors associated with non-persistence or non-adherence, respectively.
Results: Non-persistence increased from 38.5% (95% CI: 38.1, 38.9) to 56.9% (95% CI: 56.4, 57.4) after 1 and 5 years of initiation. Median time until a first 90-day gap was 1029 days (95% CI: 988, 1078) and 61% were non-adherent. After a first gap, 43.3% (95% CI: 42.7, 43.9) restarted therapy within 1 year, yet only 52.3% (95% CI: 51.4, 53.1) persisted for 1 year. Being female and a current smoker increased the risk for non-persistence and non-adherence, while older age, overweight, receiving anti-hypertensive medication or colchicine and suffering from dementia, diabetes or dyslipidaemia decreased the risk.
Conclusion: Medication adherence among gout patients starting allopurinol is poor, particularly among females and younger patients and patients with fewer comorbidities. Medication adherence remains low in those reinitiating after a first gap.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:57 |
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| Enthalten in: |
Rheumatology (Oxford, England) - 57(2018), 9 vom: 01. Sept., Seite 1641-1650 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Scheepers, Lieke E J M [VerfasserIn] |
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| Links: |
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| Themen: |
268B43MJ25 |
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| Anmerkungen: |
Date Completed 31.08.2018 Date Revised 31.08.2018 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/rheumatology/key155 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM285383892 |
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| 100 | 1 | |a Scheepers, Lieke E J M |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Medication adherence among gout patients initiated allopurinol |b a retrospective cohort study in the Clinical Practice Research Datalink (CPRD) |
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| 500 | |a Date Completed 31.08.2018 | ||
| 500 | |a Date Revised 31.08.2018 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Objectives: When urate lowering therapy is indicated in patients with gout, medication adherence is essential. This study assesses non-persistence and non-adherence in patients with newly diagnosed gout, and identifies factors associated with poor medication adherence | ||
| 520 | |a Methods: A retrospective data analysis was performed within the UK Clinical Practice Research Datalink (1987-2014) among incident gout patients, aged ⩾40 years and starting allopurinol (n = 48 280). The proportion of patients non-persistent (a first medication gap of ⩾90 days) after 1 and 5 years, and median time until a first 90-day gap was estimated using Kaplan-Meier statistics in those starting allopurinol and restarting after a first interruption. Non-adherence (proportion of days covered <80%) over the full observation period was calculated. Multivariable Cox- or logistic regressions assessed factors associated with non-persistence or non-adherence, respectively | ||
| 520 | |a Results: Non-persistence increased from 38.5% (95% CI: 38.1, 38.9) to 56.9% (95% CI: 56.4, 57.4) after 1 and 5 years of initiation. Median time until a first 90-day gap was 1029 days (95% CI: 988, 1078) and 61% were non-adherent. After a first gap, 43.3% (95% CI: 42.7, 43.9) restarted therapy within 1 year, yet only 52.3% (95% CI: 51.4, 53.1) persisted for 1 year. Being female and a current smoker increased the risk for non-persistence and non-adherence, while older age, overweight, receiving anti-hypertensive medication or colchicine and suffering from dementia, diabetes or dyslipidaemia decreased the risk | ||
| 520 | |a Conclusion: Medication adherence among gout patients starting allopurinol is poor, particularly among females and younger patients and patients with fewer comorbidities. Medication adherence remains low in those reinitiating after a first gap | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Observational Study | |
| 650 | 7 | |a Biomarkers |2 NLM | |
| 650 | 7 | |a Gout Suppressants |2 NLM | |
| 650 | 7 | |a Uric Acid |2 NLM | |
| 650 | 7 | |a 268B43MJ25 |2 NLM | |
| 650 | 7 | |a Allopurinol |2 NLM | |
| 650 | 7 | |a 63CZ7GJN5I |2 NLM | |
| 700 | 1 | |a Burden, Andrea M |e verfasserin |4 aut | |
| 700 | 1 | |a Arts, Ilja C W |e verfasserin |4 aut | |
| 700 | 1 | |a Spaetgens, Bart |e verfasserin |4 aut | |
| 700 | 1 | |a Souverein, Patrick |e verfasserin |4 aut | |
| 700 | 1 | |a de Vries, Frank |e verfasserin |4 aut | |
| 700 | 1 | |a Boonen, Annelies |e verfasserin |4 aut | |
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