Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, 266003 Qingdao, China; Institute of Metabolic Diseases, Qingdao University, 266003 Qingdao, China.
VA San Diego VA Healthcare Center, University of California San Diego, 92093 San Diego, USA.
Joint Bone Spine. 2022 Nov;89(6):105435. doi: 10.1016/j.jbspin.2022.105435. Epub 2022 Jun 28.
Urate-lowering therapy (ULT) nonadherence is common and problematic in gout. Since, sociocultural factors affect adherence, we analyzed a Chinese cohort.
We studied 903 Chinese gout patients aged 46.4±14.7 years (mean±SD), uniquely extending to assay of 2-year medication possession ratio (MPR) ≥80% defined as high adherence. Multivariable logistic regression analyses evaluated factors linked with adherence and ULT target attainment.
Characterization of ULT outcomes in this cohort revealed that after 2 years ULT, MPR ≥80% patients had better target serum urate (SU) achievement (from 23.3% to 71.0%, P <0.001), lower flare frequency and palpable tophi compared to MPR <80%. However, only 44.7% of cohort subjects had MPR ≥80%. Male sex (OR 3.68), gout onset age >60 years (OR 3.51), disease duration >5 years (OR 1.70), more comorbidities (OR 1.74), baseline palpable tophi (OR 1.53), SU <6mg/dL (360μmol/L) (OR 1.92) and more frequent follow-up visits (OR 1.98) were significantly associated with high adherence. Nevertheless, significant independent risk factors for failed SU target achievement included male sex (OR 0.36) and more comorbidities (OR 0.85).
Despite adherence to ULT linked to better outcomes for flares and tophi, the more adherent Chinese male patients and those with more comorbidities had decreased target SU attainment. Differences in adherence of Chinese gout patients compared to several primarily Western studies emphasize the importance of not stereotyping gout patients for projected nonadherence. Results underline the dual importance of identifying gout patients more likely to be ULT-adherent and leveraging adherence to drive treatment to SU target.
降低尿酸治疗（ULT）不依从在痛风中很常见且成问题。由于社会文化因素会影响依从性，我们分析了一个中国队列。
我们研究了 903 名年龄为 46.4±14.7 岁（平均值±标准差）的中国痛风患者，独特之处在于检测了 2 年药物持有率（MPR）≥80%，定义为高依从性。多变量逻辑回归分析评估了与依从性和 ULT 目标达标相关的因素。
该队列 ULT 结果的特征表明，在 2 年 ULT 后，MPR≥80%的患者有更好的目标血清尿酸（SU）达标率（从 23.3%到 71.0%，P<0.001），痛风发作频率较低，可触及痛风石减少，而 MPR<80%的患者则相反。然而，只有 44.7%的队列患者 MPR≥80%。男性（OR 3.68）、痛风发病年龄>60 岁（OR 3.51）、病程>5 年（OR 1.70）、合并症更多（OR 1.74）、基线时可触及痛风石（OR 1.53）、SU<6mg/dL（360μmol/L）（OR 1.92）和更频繁的随访就诊（OR 1.98）与高依从性显著相关。然而，SU 目标不达标的显著独立危险因素包括男性（OR 0.36）和合并症更多（OR 0.85）。
尽管 ULT 依从性与痛风发作和痛风石的更好结局相关，但更依从 ULT 的中国男性患者和合并症更多的患者 SU 目标达标率较低。与几项主要的西方研究相比，中国痛风患者的依从性差异强调了不要对痛风患者进行刻板印象预测其不依从的重要性。结果强调了确定更有可能依从 ULT 的痛风患者和利用依从性促使治疗达到 SU 目标的双重重要性。
