Allopurinol adherence among patients with gout: an Italian general practice database study

Area of Science:

• Rheumatology
• Pharmacology
• Public Health

Background:

• Allopurinol is a cornerstone for long-term gout flare prevention.
• Patient adherence to allopurinol therapy is crucial for managing hyperuricaemia (serum uric acid levels > 6 mg/dl).
• Predictors of non-adherence require identification to optimize treatment outcomes.

Purpose of the Study:

• To assess the impact of patient adherence to allopurinol on hyperuricaemia.
• To identify factors associated with non-adherence to allopurinol therapy in gout patients.

Main Methods:

• Utilized the Italian Health Search-CSD Longitudinal Patient Database (2002-2011).
• Included outpatients (≥18 years) with gout prescribed allopurinol.
• Defined adherence as ≥80% proportion of days covered; analyzed serum uric acid levels within three time-windows (30-89, 90-149, 150-365 days).
• Employed logistic regression to analyze adherence, hyperuricaemia, and non-adherence predictors.

Main Results:

• Out of 3727 patients, initial adherence was 45.9%, declining over time.
• Hyperuricaemia prevalence was significantly lower in adherent patients across all time windows (e.g., 32.6% vs. 66.4% at 150-365 days).
• Adherence strongly correlated with reduced hyperuricaemia risk (ORs ranging from 0.49 to 0.23).
• Hypertension and a history of gout flares were associated with significantly better adherence.

Conclusions:

• Monitoring patient adherence to allopurinol is essential for effective gout management.
• Enhanced physician-patient communication is vital for improving allopurinol adherence.
• Targeted interventions may be needed for patients with identified non-adherence predictors.