title: Uric acid lowering therapy: prescribing patterns in a large cohort of older adults.
abstract: BACKGROUND
  Uric acid lowering therapy (UALT) is considered a chronic treatment for gout. Relatively little is known about adherence to UALT.
  
  
  METHODS
  We assessed adherence with UALT over a 1-year study period among 9823 older adults enrolled in a pharmacy benefit program. 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 <80% was considered poor adherence and its predictors were examined in multivariable logistic models.
  
  
  RESULTS
  The mean (SD) PDC was 54% (36%) with 64% of patients considered poorly compliant over the study period. A total of 56% had experienced an extended break in UALT. Predictors of poor adherence included younger age (odds ratio (OR) 1.50, 95% CI 1.33-1.69 for ages 65-74 compared with 85 and above) and African-American race (OR 1.86, 95% CI 1.52-2.27 compared with Caucasian race). Most patients (93%) received their initial UALT prescription from a non-specialist and this also predicted poor adherence (OR 1.15, 95% CI 0.96-1.38 compared with rheumatologists or nephrologists).
  
  
  CONCLUSIONS
  Adherence with UALT is poor. While uric acid levels were not measured in this study, poor adherence with UALT is likely to reduce attainment of goal uric acid levels.
authors.affiliation: Division of Pharmacoepidemiology, Brigham and Women's Hospital, 1620 Tremont Street, Suite 3030, Boston, MA 02120, USA. dhsolomon@partners.org
authors.forename: D H
authors.initials: DH
authors.lastname: Solomon
authors.forename: J
authors.initials: J
authors.lastname: Avorn
authors.forename: R
authors.initials: R
authors.lastname: Levin
authors.forename: M A
authors.initials: MA
authors.lastname: Brookhart
mesh_terms: D001741:Black or African American; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000493:Allopurinol / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D015331:Cohort Studies; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006073:Gout / Q000188:drug therapy* / Q000208:ethnology / Q000523:psychology*; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008404:Massachusetts; D010349:Patient Compliance; D011339:Probenecid / Q000627:therapeutic use; D013442:Sulfinpyrazone / Q000627:therapeutic use; D044465:White People
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D006074:Gout Suppressants; D000493:Allopurinol; D011339:Probenecid; D013442:Sulfinpyrazone