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.
Rheumatology (Oxford). 2018 Sep 1;57(9):1641-1650. doi: 10.1093/rheumatology/key155.
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.
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.
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.
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.
当需要降低尿酸治疗时，痛风患者必须坚持用药。本研究评估了新诊断痛风患者的不持续性和不依从性，并确定了与药物治疗依从性差相关的因素。
在英国临床实践研究数据库（1987-2014 年）中对年龄 ⩾40 岁且开始使用别嘌醇的新诊断痛风患者（n=48280）进行了回顾性数据分析。使用 Kaplan-Meier 统计方法估计在开始使用别嘌醇并在首次中断后重新开始治疗的患者中，1 年和 5 年后首次出现 ⩾90 天用药间隔的患者比例，以及首次出现 90 天间隔的中位时间。计算整个观察期内的不依从性（覆盖率 ⩽80%的天数比例）。多变量 Cox 或逻辑回归分别评估与不持续性或不依从性相关的因素。
起始后 1 年和 5 年的不持续性分别从 38.5%（95%CI：38.1，38.9）增加到 56.9%（95%CI：56.4，57.4）。首次出现 90 天间隔的中位时间为 1029 天（95%CI：988，1078），61%的患者不依从。在首次出现间隔后，43.3%（95%CI：42.7，43.9）的患者在 1 年内重新开始治疗，但只有 52.3%（95%CI：51.4，53.1）在 1 年内持续治疗。女性和当前吸烟者增加了不持续性和不依从性的风险，而年龄较大、超重、接受抗高血压药物或秋水仙碱治疗以及患有痴呆、糖尿病或血脂异常则降低了风险。
开始使用别嘌醇的痛风患者的药物治疗依从性较差，特别是女性和年轻患者以及合并症较少的患者。在首次出现间隔后重新开始治疗的患者中，药物治疗依从性仍然较低。
