The American Journal of Medicine
Volume 123, Issue 1 , Pages 54-59, January 2010

The Dynamics of Chronic Gout Treatment: Medication Gaps and Return to Therapy

  • Leslie R. Harrold, MD, MPH

      Affiliations

    • Meyers Primary Care Institute, Worcester, Mass
    • University of Massachusetts Medical School, Worcester, Mass
    • Health Maintenance Organization Research Network Center for Education and Research in Therapeutics, Denver
    • Corresponding Author InformationRequests for reprints should be addressed to Leslie R. Harrold, MD, MPH, Department of Medicine, University of Massachusetts Medical School, Biotech 4, Suite 315, 377 Plantation Street, Worcester, MA 01605
    • ,
  • Susan E. Andrade, ScD

      Affiliations

    • Meyers Primary Care Institute, Worcester, Mass
    • University of Massachusetts Medical School, Worcester, Mass
    • Health Maintenance Organization Research Network Center for Education and Research in Therapeutics, Denver
    • ,
  • Becky Briesacher, PhD

      Affiliations

    • Meyers Primary Care Institute, Worcester, Mass
    • University of Massachusetts Medical School, Worcester, Mass
    • ,
  • Marsha A. Raebel, Pharm D

      Affiliations

    • Kaiser Permanente Colorado, Denver
    • Health Maintenance Organization Research Network Center for Education and Research in Therapeutics, Denver
    • ,
  • Hassan Fouayzi, MS

      Affiliations

    • Meyers Primary Care Institute, Worcester, Mass
    • University of Massachusetts Medical School, Worcester, Mass
    • ,
  • Robert A. Yood, MD

      Affiliations

    • Meyers Primary Care Institute, Worcester, Mass
    • University of Massachusetts Medical School, Worcester, Mass
    • Fallon Clinic, Worcester, Mass
    • Health Maintenance Organization Research Network Center for Education and Research in Therapeutics, Denver
    • ,
  • Ira S. Ockene, MD

      Affiliations

    • University of Massachusetts Medical School, Worcester, Mass

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.

Keywords: Adherence, Compliance, Gout, Persistence, Urate-lowering drugs

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 Funding: This work was supported by Grant Number K23AR053856 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (Bethesda, Md). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Arthritis and Musculoskeletal and Skin Diseases or the National Institutes of Health.

 Conflict of Interest: We have no conflict of interest to declare for this work.

 Authorship: All authors listed on the manuscript had access to the data and contributed sufficiently to the project to qualify as authors.

PII: S0002-9343(09)00710-4

doi:10.1016/j.amjmed.2009.05.026

The American Journal of Medicine
Volume 123, Issue 1 , Pages 54-59, January 2010

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