Adherence and Outcomes with Urate-Lowering Therapy: A Site-Randomized Trial

Area of Science:

• Pharmacology
• Clinical Pharmacy
• Rheumatology

Background:

• Gout management requires consistent adherence to treatment and achieving target serum urate levels.
• Improving patient adherence to urate-lowering therapy is crucial for long-term gout outcomes.

Purpose of the Study:

• To evaluate a pharmacist-led intervention, delivered via automated telephone technology, to enhance gout treatment adherence and outcomes.
• To assess the impact of the intervention on serum urate levels and gout flares.

Main Methods:

• A site-randomized trial involving 1463 patients with gout initiating allopurinol.
• Comparison of a 1-year pharmacist-led intervention against usual care.
• Co-primary outcomes included adherence (proportion of days covered ≥0.8) and serum urate <6.0 mg/dL at 1 year, with follow-up at year 2.

Main Results:

• Intervention group showed significantly higher adherence (50% vs 37%) and serum urate goal achievement (30% vs 15%) compared to usual care.
• At year 2, differences in serum urate goal remained significant, but adherence differences were attenuated.
• A trend towards reduced gout flares in year 2 was observed but did not reach statistical significance.

Conclusions:

• A pharmacist-led intervention using automated telephone technology effectively improved adherence and serum urate control in gout patients starting allopurinol.
• The 'light-touch' intervention demonstrated efficacy, but enhanced patient engagement strategies are necessary for sustained gout management.
• Further research should focus on optimizing patient engagement to maximize long-term benefits in gout care.