title: Adherence and persistence to urate-lowering therapies in the Irish setting.
abstract: To identify adherence and persistence levels with urate-lowering therapies using the national administrative pharmacy claim database. This was a retrospective, pharmacy claims-based analysis of dispensed anti-gout medications on the Irish national HSE-PCRS scheme database between January 2008 and December 2012. Adherence is defined by the medication possession ratio (MPR), and patients were considered to be adherent if the MPR ≥80 % (good adherers) in any given time period. Persistence was defined as continued use of therapy with no periods exceeding a refill gap of >63 days (9 weeks). Logistic regression analysis was used to predict odd ratios (OR) and 95 % confidence interval (CI) for persistence and adherence in relation to age, gender and level of comorbidity. There was a 53 % increase in the number of patients prescribed anti-gout medications between 2008 and 2012 with an increase of 27 % in the associated ingredient cost of these medications. Allopurinol accounted for 87 % of the prescribing and febuxostat accounted for a further 9 %. In patients who started on 100 mg allopurinol, only 14.6 % were titrated to the 300 mg dose. For all those initiating urate-lowering therapies, 45.8 % of patients were persistent with treatment at 6 months decreasing to 22.6 % at 12 months. In multivariate analysis, females had poorer adherence (OR = 0.83 (0.77-0.90)), and increasing age was associated with increased adherence (OR = 4.19 (2.53-6.15)) Increasing comorbidity score was associated with increased adherence and persistence at 6 months (OR = 0.68 (0.59-0.79)). Adherence with anti-gout medications in this study cohort was relatively low. Sustained treatment for gouty arthritis is essential in the prevention of serious adverse outcomes.Significance and Innovations-Poor adherence to medications prescribed to patients for the management of chronic diseases such as gout is an ongoing problem which urgently needs to be addressed.-Some of the reasons identified for poor adherence to anti-gout medications include the risk of flare of acute gout with the initiation of urate-lowering therapy (ULT), poor response to ULT and persistence of attacks of acute gout, suboptimal dosing of allopurinol therapy and intolerance of allopurinol.-The results of this study identified adherence and persistence rates of approximately 50 % at 6 months which is in line if not lower than many of the other published studies to date which have measured adherence and persistence using pharmacy claims databases.-The results of poor adherence and persistence affect both the health of the patients with financial implications for the healthcare service.
authors.affiliation: The North Western Rheumatology Unit, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland. mcgowab@tcd.ie.
authors.forename: Bernie
authors.initials: B
authors.lastname: McGowan
authors.affiliation: The Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland.
authors.forename: Kath
authors.initials: K
authors.lastname: Bennett
authors.affiliation: The North Western Rheumatology Unit, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland.
authors.forename: Carmel
authors.initials: C
authors.lastname: Silke
authors.affiliation: The North Western Rheumatology Unit, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland.|The Department of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: Bryan
authors.initials: B
authors.lastname: Whelan
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000493:Allopurinol / Q000627:therapeutic use*; D016208:Databases, Factual; D000069465:Febuxostat / Q000627:therapeutic use*; D005260:Female; D006073:Gout / Q000097:blood / Q000188:drug therapy*; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D007494:Ireland; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D014527:Uric Acid / Q000097:blood*; D055815:Young Adult
chemical_list: D006074:Gout Suppressants; D000069465:Febuxostat; D014527:Uric Acid; D000493:Allopurinol
keywords: Adherence; Gout; Pharmacy claims database; Urate-lowering therapy