THU0424 SHORT-TERM ADHERENCE OF URATE-LOWERING AGENTS WILL NOT IMPROVE END-STAGE RENAL DISEASE AND MORTALITY
Authors: Y. F. Fang, L. J. Wu, S. W. Chang
Journal: Annals of the Rheumatic Diseases (2020)

Background: Gout is the most common inflammatory arthritis worldwide with a diverse spectrum of clinical manifestations. Many studies indicated that gout is associated with hypertension, metabolic syndrome, chronic kidney disease and ischaemic heart diseases. Objectives: This study investigated the association between the compliance of urate-lowering agents (ULA) compliance and progression end-stage renal disease (ESRD) and all-cause mortality. Methods: We identified 53,917 patients with incident gout from 2002 to 2012. We followed up these patients till 31DEC2015. The primary data source was the National Health Insurance database of Taiwan. Proportion of days covered (PDC) was used to measure medication adherence. Patients with PDC≧80% more than two years defined adherence to ULA. Cox proportional hazards model was used to estimate difference and hazard ratios (HRs) for ESRD and all-cause mortality. Results: A total of 53,917 patients were included (figure 1). Patient with urate-lowering agent PDC≧80% more than 2 years were 2,371. After propensity score matched 1:4 with age, sex and comorbidities, PDC &lt;80% were 9,484 matched cohort (Table 1). The mean follow-up duration is 12.30±2.45 years in PDC≧80% group and 9.52±3.46 years in PDC &lt;80%. During follow-up, ESRD was detected in 1,349 patients (306 with PDC≧80% and 1,043 with PDC &lt;80%) and all-cause mortality was found 3,430 patients (842 with PDC≧80% and 2,588 with PDC &lt;80%). This matching showed no difference in ESRD (HR, 0.91; 95% CI, 0.80-1.03) and all-cause mortality (HR, 0.96; 95% CI, 0.88-1.03) (Table 2). Table 1. Baseline characteristic of adherence and non-adherence of urate-lowering agent among patients with gout in matched and unmatched cohort Unmatched Cohort Propensity-score Matched Cohort Variable PDC≧80% N=2371^ PDC&lt;80% N=51546^ P PDC≧80% N=2371^ PDC&lt;80% N=9484^ P Age (years) (mean ± standard deviation) 59.96±13.44 51.52±15.61 &lt;0.0001 59.96±13.44 60.23±13.41 0.3755 follow-up duration (years) (mean ± standard deviation) 12.30±2.45 9.52±3.46 Gender 0.3098 0.2855 Male 1929(81.36%) 42358(82.18%) 1929(81.36%) 7624(80.39%) Female 442(18.64%) 9188(17.82%) 442(18.64%) 1860(19.61%) Comorbidities Hypertension 406(17.12%) 3695(7.17%) 1.71E-71 406(17.12%) 1571(16.56%) 0.5138 Diabetes Mellitus 276(11.64%) 2367(4.59%) 1.78E-54 276(11.64%) 1080(11.39%) 0.7291 Ischemic heart disease 109(4.60%) 988(1.92%) 1.58E-19 109(4.60%) 444(4.68%) 0.8617 Cerebrovascular disease 113(4.77%) 891(1.73%) 1.05E-26 113(4.77%) 481(5.07%) 0.5416 Peripheral arterial disease 20(0.84%) 170(0.33%) 3.67E-05 20(0.84%) 74(0.78%) 0.7561 Congestive heart failure 81(3.42%) 606(1.18%) 1.88E-21 81(3.42%) 286(3.02%) 0.3137 Anemia 182(7.68%) 1559(3.02%) 5.22E-36 182(7.68%) 769(8.11%) 0.4882 CKD 266(11.22%) 1978(3.84%) 2.61E-69 266(11.22%) 963(10.15%) 0.1281 Table 2. hazard ratio of ESRD and all-cause mortality in patients with gout Outcome Hazard ratio (95% Confidence interval) ESRD ULA adherence level PDC&lt;80% Reference PDC≧80% 0.91 (0.80-1.03) All-cause mortality ULA adherence level PDC&lt;80% Reference PDC≧80% 0.96 (0.88-1.03) PDC= Proportion of days covered Figure 1. Flow chart for study design Conclusion: Gout patients with/without two years adherence of urate-lowering agents does not have an impact on ESRD and all-cause mortality. References: Nil Disclosure of Interests: : None declared