D to treat acute gout, prior to ULD initiation was also
D to treat acute gout, prior to ULD initiation was also significantly associated with non-adherence and the relationship persisted even when we controlled for use of prophylactic FT011 site medications prior to ULD initiation. This suggests that patients with likely inadequately controlled gout prior to ULD initiation (reflecting the need for prescription NSAIDs) are less adherent. This finding was contrary to our a priori hypothesis that active gout would be linked to higher adherence. Interestingly, lack of prophylactic medications (NSAIDs or colchicine dispensed in the 30 days prior to and including the date of ULD initiation) was not associated with non-adherence. These results have practical implications for clinicians. While many providers assume patients with painful arthritic conditions are adherent to their medications, our work has shown that this is not the case. Providers and health care systemsPage 5 of(page number not for citation purposes)Arthritis Research TherapyVol 11 NoHarrold et al.Table 3 Adjusted logistic regression model for non-adherence (medication possession ratio (MPR) < 0.80)* Variable Sociodemographic: Gender, female Age <45 45 to 49 50 to 54 55 to 59 60 to 64 65 to 69 70 to 74 75 + Health status: Charlson comorbidity score 0 1 2 3 or more Gout care: Number of provider visits for gout prior to ULD initiation 0 1 2 3 or more Use of acute gout meds 1 to 12 months prior to urate-lowering drug initiation NSAIDs 1.15 (1.00 to 1.31) 1.28 (1.05 to 1.55) 1.09 (0.92 to 1.30) 1.00 (0.83 to 1.21) PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/29072704 1.00 1.46 (1.20 to 1.77) 1.21 (0.98 to 1.51) 1.20 (0.94 to 1.53) 1.00 2.43 (1.86 to 3.18) 1.45 (1.08 to 1.93) 1.09 (0.86 to 1.39) 0.78 (0.61 to 0.99) 0.75 (0.59 to 0.96) 0.84 (0.67 to 1.04) 0.83 (0.67 to 1.02) 1.00 1.03 (0.88 to 1.19) Adjusted odds ratio (95 confidence interval)*A backward elimination method was used retaining all variables considered to be potentially important. Variables with P values < 0.10 remained in the final models. The Hosmer-Lemeshow goodness of fit had a P value of 0.70; model after controlling for health plan. NSAID, non-steroidal anti-inflammatory drug; ULD, urate-lowering drug.levels. We also did not have access to the specialty of the ULD prescriber and thus could not examine whether adherence was influenced by provider specialty, specifically whether patients cared for by rheumatologists were more adherent. In addition, we were unable to determine definitely if visits associated with a diagnosis of gout were for acute gout flares versus routine follow-up appointments. Therefore, we could not directly determine the relationship between adherence and the frequency of gout attacks. Lastly, the population was overwhelming Caucasian, and thus we could not examine whether patient race and ethnicity influenced adherence.ConclusionsNon-adherence with ULDs for the treatment of chronic gout occurred in the majority of the study population. While further research is needed to assess the clinical and economic consequences of non-adherence, it is likely the patients did not achieve the recommended reduction in serum urate levels and thus are at risk for future gout flares, nephrolithiasis and boney erosions. Providers should be aware of the magnitude of the problem of non-adherence with ULDs, and counsel patients on the need for ULD adherence.Competing interestsThe authors declare that they have no competing interests.Page 6 of(page number not for citation purposes)Available online http://arthritis-research.com/cont.
