| アブストラクト | Objectives: When urate lowering therapy is indicated in patients with gout, medication adherence is essential. This study assesses non-persistence and non-adherence in patients with newly diagnosed gout, and identifies factors associated with poor medication adherence. Methods: A retrospective data analysis was performed within the UK Clinical Practice Research Datalink (1987-2014) among incident gout patients, aged 40 years and starting allopurinol (n = 48 280). The proportion of patients non-persistent (a first medication gap of 90 days) after 1 and 5 years, and median time until a first 90-day gap was estimated using Kaplan-Meier statistics in those starting allopurinol and restarting after a first interruption. Non-adherence (proportion of days covered <80%) over the full observation period was calculated. Multivariable Cox- or logistic regressions assessed factors associated with non-persistence or non-adherence, respectively. Results: Non-persistence increased from 38.5% (95% CI: 38.1, 38.9) to 56.9% (95% CI: 56.4, 57.4) after 1 and 5 years of initiation. Median time until a first 90-day gap was 1029 days (95% CI: 988, 1078) and 61% were non-adherent. After a first gap, 43.3% (95% CI: 42.7, 43.9) restarted therapy within 1 year, yet only 52.3% (95% CI: 51.4, 53.1) persisted for 1 year. Being female and a current smoker increased the risk for non-persistence and non-adherence, while older age, overweight, receiving anti-hypertensive medication or colchicine and suffering from dementia, diabetes or dyslipidaemia decreased the risk. Conclusion: Medication adherence among gout patients starting allopurinol is poor, particularly among females and younger patients and patients with fewer comorbidities. Medication adherence remains low in those reinitiating after a first gap. |
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| ジャーナル名 | Rheumatology (Oxford, England) |
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| 投稿日 | 2018/6/13 |
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| 投稿者 | Scheepers, Lieke E J M; Burden, Andrea M; Arts, Ilja C W; Spaetgens, Bart; Souverein, Patrick; de Vries, Frank; Boonen, Annelies |
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| 組織名 | Department of Internal Medicine, Division of Rheumatology, Maastricht University;Medical Centre, Maastricht, The Netherlands.;Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of;Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.;School for Public Health and Primary Care (CAPHRI), Maastricht University Medical;Centre, Maastricht, The Netherlands.;Department of Clinical Pharmacy and Toxicology, Maastricht University Medical;Department of Epidemiology, CARIM School for Cardiovascular Diseases, MaCSBio;Maastricht Centre for Systems Biology, Maastricht University, Maastricht, The;Netherlands. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/29893941/ |
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