title: Allopurinol adherence among patients with gout: an Italian general practice database study.
abstract: OBJECTIVE
  Allopurinol is used as long-term therapy to reduce the occurrence of gout flares. This study estimated the impact of patient adherence to allopurinol on hyperuricaemia (serum uric acid levels, sUA > 6 mg/dl) and the identification of non-adherence predictors.
  
  
  METHODS
  The Italian Health Search-CSD Longitudinal Patient Database was accessed to identify outpatients aged ≥ 18 years with gout and prescribed with allopurinol during the years 2002-2011. Patients with a proportion of days covered ≥ 80% were considered adherent to allopurinol. Data on sUA levels over the first year of therapy were categorised in three time-windows (30-89; 90-149; 150-365 days). Logistic regressions were used to estimate the association between adherence and hyperuricaemia, as well as non-adherence predictors.
  
  
  RESULTS
  A total of 3727 patients were included. In the interval 0-29 days, the proportion of patients adherent to allopurinol was 45.9%, while up to 89, 149 and 365 days the percentages were 16.7%, 10.0% and 3.2%, respectively. The proportions of hyperuricaemic patients for each time-window were 43.1%, 42.4%, 32.6% and 59.0%, 64.0%, 66.4% among adherent and non-adherent patients, respectively. In the multivariable analysis, adherence was associated with a significant lower risk of hyperuricaemia. The adjusted ORs were 0.49 (95% CI: 0.33-0.73), 0.40 (95% CI: 0.24-0.67) and 0.23 (95% CI: 0.15-0.34) for the first, second and third time-window, respectively. Patients with hypertension (adjusted OR = 0.64, 95% CI: 0.42-0.99) and history of gout flares (adjusted OR = 0.55, 95% CI: 0.32-0.95) were significantly adherent to allopurinol.
  
  
  CONCLUSIONS
  Adherence monitoring in patients with gout is pivotal to ensure the effectiveness of therapy. To gain a better patient adherence, the communication between physicians and patients should be improved.
authors: Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors: S
authors: S
authors: Mantarro
authors: Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors: A
authors: A
authors: Capogrosso-Sansone
authors: Unit of Adverse Drug Reaction Monitoring, University Hospital of Pisa, Pisa, Italy.
authors: M
authors: M
authors: Tuccori
authors: Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.|Unit of Adverse Drug Reaction Monitoring, University Hospital of Pisa, Pisa, Italy.
authors: C
authors: C
authors: Blandizzi
authors: Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors: S
authors: S
authors: Montagnani
authors: Unit of Adverse Drug Reaction Monitoring, University Hospital of Pisa, Pisa, Italy.
authors: I
authors: I
authors: Convertino
authors: Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors: L
authors: L
authors: Antonioli
authors: Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors: M
authors: M
authors: Fornai
authors: Health Search, Italian College of General Practitioners, Florence, Italy.
authors: I
authors: I
authors: Cricelli
authors: Health Search, Italian College of General Practitioners, Florence, Italy.
authors: S
authors: S
authors: Pecchioli
authors: Italian College of General Practitioners, Florence, Italy.
authors: C
authors: C
authors: Cricelli
authors: Health Search, Italian College of General Practitioners, Florence, Italy.
authors: F
authors: F
authors: Lapi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000493:Allopurinol / Q000008:administration & dosage*; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D058006:General Practice / Q000592:standards*; D006073:Gout / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D006074:Gout Suppressants / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D007558:Italy; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012189:Retrospective Studies; D013997:Time Factors; D014527:Uric Acid / Q000097:blood*; D055815:Young Adult
chemical_list: D006074:Gout Suppressants; D014527:Uric Acid; D000493:Allopurinol