SAT0407 GOUT PATIENTS ARE GETTING MORE POSITIVE ABOUT THEIR MEDICINES WHILE TREATED TO TARGET: DATA FROM THE NOR-GOUT STUDY
Authors: Jon Anders Grønvold, Sebastian James Hekneby, Lars Fridtjof Karoliussen, Espen A. Haavardsholm, Tore K. Kvien, Hilde Berner Hammer, Till Uhlig
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Low adherence to medication is a concern in gout where urate lowering therapy (ULT) is indicated to prevent disease severity and comorbidities. Not believing in medication may impact on the success of achieving these treatment goals. <h3>Objectives:</h3> To study which factors were associated to and predictive of beliefs about medicines during one year in patients with a recent gout attack and a need for ULT. <h3>Methods:</h3> Baseline data from a prospective observational study were used in patients with crystal-proven gout after a recent gout flare and insufficiently treated serum urate (sUA) level (&gt;360 μmol/L/&gt;6 mg/dl). In these patients a treat-to-target approach was planned to meet the treatment target (sUA &lt;360 μmol/L, or &lt;300 μmol/L if clinical tophi). Assessments included demographic and clinical data, baseline serum urate levels, medication, comorbidities, physical function (HAQ), and SF-36 mental (MCS) and physical component summary scores. The Beliefs in Medicines Questionnaire (BMQ)(1) queries patient beliefs about medicines on four subscales (necessity and concerns specific for the patient, generally on overuse and harm). Respondents indicated their degree of agreement with each individual statement about medicines on a 5-point Likert scale, (1=strongly disagree to 5=strongly agree). Scores within the four subscales were summed (ranges 5-25 for necessity and concern, 4-20 for overuse and harm). Calculation of the difference between necessity and concern shows the relative importance of patients' view on taking medication, and was grouped as high and low relative to the median. Using multivariate analysis with logistic regression, baseline variables were explored as predictors of high beliefs in the relative importance of medication after 12 months. <h3>Results:</h3> 202 patients were included at baseline, 94.1% men, 90.3% caucasian, mean (SD) age 56.6 (14.2) years, disease duration 8.0 (7.7) years). Mean sUA level was 494 (SD 86.8) μmol/L at baseline, body mass index 28.9 (4.6) kg/m2, and physical function (HAQ) 0.36 (0.57). 18.8% (n=28) had tophi, and 30.4% (n=55) were previous users of allopurinol. During the first year the beliefs in necessity of medication and the perceived importance of medication increased, while the concerns decreased (Table). Bivariate comparisons studying demographic, medication and clinical variables did not show consistent cross-sectional associations with beliefs in the importance of medication. However, after 12 months, bivariate comparisons revealed statistically significant differences in mental health (SF36 MCS), physical function (HAQ) and self-efficacy for symptom control. In logistic regression analyses, adjusting for age,gender, BMI and comorbidites, prediction of high beliefs in the relative importance of medication after 12 months were independently associated with baseline self-efficacy for symptom control (OR 1.04 per unit, 95% CI 1.01-1.06). <h3>Conclusion:</h3> During one year of treat-to-target strategy in patients with gout, perceived necessity of medication and higher importance of medication increases. Self-efficacy for symptom control at baseline was an independent predictor of high beliefs in importance of medication after 12 months. These findings support that patients increase their perception of the necessity of beliefs in medication during a treat-to-target approach with ULT. <h3>Reference</h3> [1] Horne R, et al. Psychology &amp; Health, 1999. 14(1): 1–24. <h3>Disclosure of Interests:</h3> Jon Anders Grønvold: None declared, Sebastian James Hekneby: None declared, Lars Fridtjof Karoliussen: None declared, Espen A Haavardsholm Grant/research support from: research funding from Pfizer, UCB, Roche, MSD, and AbbVie., Tore K. Kvien Grant/research support from: AbbVie, BMS, MSD, Pfizer, Roche and UCB., Consultant for: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Hospira, Merck-Serono, MSD, Novartis, Oktal, Orion Pharma, Pfizer, Roche, Sandoz, Sanofi, Mylan and UCB, Speakers bureau: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Hospira, Merck-Serono, MSD, Novartis, Oktal, Orion Pharma, Pfizer, Roche, Sandoz, Sanofi and UCB, Hilde Berner Hammer Speakers bureau: speakers fee from AbbVie, Bristol-Myers Squibb, Roche, UCB Pharma and Pfizer, Till Uhlig Consultant for: Grünenthal, Novartis, Speakers bureau: Grünenthal, Novartis