SAT0357 Compliance and persistence to urate lowering therapy for the treatment of gout and hyperuricemia: a retrospective analysis of medication prescription records
Authors: C.A. Janssen, M.A. Oude Voshaar, H.E. Vonkeman, M. Krol, M.A. van de Laar
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Hyperuricemia is the predominant risk factor for gout, a common crystal-induced disease, manifested as an acute inflammatory arthritis. Urate lowering therapy (ULT) is an effective and recommended life-long treatment for lowering and managing serum urate levels in gout patients.<sup>1</sup> However, recurrent attacks of gouty arthritis are commonly observed in practice, even during long-term ULT.<sup>2</sup> This is often attributed to poor medication adherence and continuance.<sup>3</sup> Gaining insight into the dispensing patterns and medication adherence of ULT, provides a reflection of the current gout care delivered by health professionals. <h3>Objectives</h3> To examine the levels of compliance and persistence to commonly prescribed ULT for the treatment of hyperuricemia and gout in the Netherlands. <h3>Methods</h3> Anonymous medication prescription records were obtained from IQVIA's longitudinal prescription database in The Netherlands, containing ULT dispensing data (allopurinol, febuxostat and benzbromarone) from November 2013 to July 2017. Compliance to ULT was determined by calculating the proportion of days covered (PDC) over a period of 12 consecutive months. Good compliance was defined as a PDC≥0.80. Persistence over 12 months was evaluated by determining the time to discontinuation, without surpassing a refill gap of &gt;30 days. The association of PDC and persistence with age, gender and first prescriber were examined using beta regression- and cox-regression models, respectively. <h3>Results</h3> In total, 45 654 patients were identified meeting the enrollment criteria, of which 76.1% were male. The initial ULT drug prescribed most frequently among general practitioners and rheumatologists was allopurinol 100 mg, 75.9% and 72.1%, respectively. In total, 51.7% of the cases had good compliance after one year. The median time to discontinuation was 248 days, and after one year 42.7% of the cases were still persistent. In general, men, older patients and patients whose first prescriber was a rheumatologist were more persistent, and had a higher PDC, although effect sizes were modest (table 1 and Abstract SAT0357 – figure 1). <h3>Conclusions</h3> Our results show that medication adherence to ULT after one year is suboptimal, considering that current guidelines recommend ULT as a life-long treatment. Future studies addressing the reasons for treatment cessation and improving treatment adherence are warranted. <h3>References</h3> [1] Richette P, Doherty M, Pascual E, et al. 2016updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis2017;76:29–42. [2] Doherty M, Jansen TL, Nuki G, et al. Gout: why is this curable disease so seldom cured?Ann Rheum Dis2012;71:1765–70. [3] Aung T, Myung G, FitzGerald JD. Treatment approaches and adherence to urate-lowering therapy for patients with gout. Patient Prefer Adherence2017;11:795–800. <h3>Acknowledgements</h3> This study was supported by Grünenthal B.V. <h3>Disclosure of Interest</h3> C. Janssen: None declared, M. Oude Voshaar: None declared, H. Vonkeman: None declared, M. Krol: None declared, M. van de Laar Grant/research support from: Our department received an unrestricted education grant by Grünenthal B.V. to perform this study., Consultant for: MvdL received consultancy fees from Grünenthal B.V.