University of Toronto and Sunnybrook Research Institute, Holland Bone & Joint Program, Toronto, Ontario, Canada.
University of Toronto, Toronto, Ontario, Canada.
Arthritis Care Res (Hoboken). 2024 Oct;76(10):1379-1389. doi: 10.1002/acr.25380. Epub 2024 Jun 23.
We sought to evaluate urate-lowering therapy (ULT) adherence and treatment-to-target (T2T) serum uric acid (SUA) levels among older adults with gout starting ULT.
We performed a population-based retrospective cohort study in Ontario, Canada in patients with gout aged ≥66 years newly dispensed ULT between 2010 and 2019. We defined successful T2T as patients having SUA levels <360 μmol/L (6 mg/dL) within 12 months after ULT dispensation. We also assessed adherence to ULT. Multilevel logistic regression clustered by ULT prescriber evaluated patient, physician, and prescription factors associated with reaching target SUA levels.
Among 44,438 patients (mean ± SD age 76.0 ± 7.3 years; 64.4% male), 30,057 (67.6%) patients had ≥1 SUA test completed. Overall, 52.3% patients reached SUA target within 12 months, improving from 45.2% in 2010 to 61.2% in 2019 (P < 0.0001). ULT adherence was 55.3% overall and improved annually. Key factors associated with achieving T2T included febuxostat treatment (odds ratio [OR] 11.40, 95% confidence interval [95% CI] 5.10-25.43) (was only dispensed in 88 patients), ULT adherence (OR 5.17, 95% CI 4.89-5.47), allopurinol starting doses >50 mg (OR 2.53, 95% CI 2.14-2.99), colchicine/oral glucocorticoids co-prescription (OR 1.24, 95% CI 1.14-1.34), and ULT prescription from a rheumatologist.
Only 52.3% of patients achieved an optimal SUA level within 1 year of ULT initiation. ULT adherence was suboptimal, although improving over time. ULT adherence and higher allopurinol starting doses had the strongest associations of achieving a target SUA level. This study highlights room for improvement in gout management and potential strategies to address care gaps.
我们旨在评估开始降尿酸治疗（ULT）的老年痛风患者的 ULT 依从性和治疗达标（T2T）血清尿酸（SUA）水平。
我们在加拿大安大略省进行了一项基于人群的回顾性队列研究，纳入 2010 年至 2019 年间新开具 ULT 的年龄≥66 岁的痛风患者。我们将 T2T 定义为患者在 ULT 开具后 12 个月内 SUA 水平＜360μmol/L（6mg/dL）。我们还评估了 ULT 的依从性。采用按 ULT 开具者分层的多水平逻辑回归评估与达到目标 SUA 水平相关的患者、医生和处方因素。
在 44438 名患者（平均年龄 76.0±7.3 岁；64.4%为男性）中，有 30057 名（67.6%）患者完成了≥1 次 SUA 检测。总体而言，52.3%的患者在 12 个月内达到 SUA 目标，这一比例从 2010 年的 45.2%提高到 2019 年的 61.2%（P＜0.0001）。ULT 依从性总体为 55.3%，且逐年提高。与实现 T2T 相关的关键因素包括非布司他治疗（比值比[OR]11.40，95%置信区间[95%CI]5.10-25.43）（仅在 88 名患者中开具）、ULT 依从性（OR 5.17，95%CI 4.89-5.47）、别嘌醇起始剂量＞50mg（OR 2.53，95%CI 2.14-2.99）、秋水仙碱/口服糖皮质激素联合处方（OR 1.24，95%CI 1.14-1.34）和风湿病医生开具 ULT 处方。
只有 52.3%的患者在开始 ULT 治疗后 1 年内达到了理想的 SUA 水平。ULT 依从性不理想，但随着时间的推移有所改善。ULT 依从性和较高的别嘌醇起始剂量与实现目标 SUA 水平的关联最强。本研究强调痛风管理仍有改进空间，可能需要采取策略来解决护理差距。
