Why Do Patients With Gout Not Take Allopurinol?

Area of Science:

• Rheumatology
• Pharmacology
• Patient Adherence Research

Background:

• Gout management requires consistent urate-lowering therapy (ULT) like allopurinol.
• Nonadherence to allopurinol can lead to suboptimal serum urate (SU) control and treatment failure.
• Understanding patient-reported reasons for nonadherence is crucial for improving treatment outcomes.

Purpose of the Study:

• To identify patient-reported reasons for nonadherence to allopurinol.
• To compare intentional nonadherence between patients achieving and not achieving target SU levels.
• To explore demographic differences in allopurinol nonadherence.

Main Methods:

• Sixty-nine men with gout on allopurinol for at least 6 months completed the Intentional Non-Adherence Scale (INAS).
• Analysis focused on differences in nonadherence reasons based on achieving target SU levels (< 0.36 mmol/L).
• Demographic factors (age, marital status, ethnicity) were examined in relation to nonadherence.

Main Results:

• Top reasons for nonadherence included desiring a normal life (23%) and feeling healthy again (20%).
• Testing the need for medication was a significant reason for nonadherence (22%).
• Patients above SU target reported more concerns, endorsed more nonadherence reasons, and cited 'testing treatment' more frequently. Younger, single, and non-New Zealand European patients also reported more reasons for nonadherence.

Conclusions:

• Key drivers of allopurinol nonadherence are the desire for normalcy and self-monitoring treatment effectiveness.
• These findings suggest modifiable targets for adherence interventions.
• Clinicians should reframe ULT discussions to enhance patient adherence and improve gout management.