Improving Adherence to Allopurinol: Insights from Patients with Gout

Patient motivation to prevent gout flares, along with their trust in healthcare professionals (HCPs), were facilitators of treatment adherence after initiation of allopurinol. Reluctance to commence long-term medication was a barrier to allopurinol introduction.¹

The recent results emphasized the importance of accurate medical advice and feedback on urate control to improve adherence to allopurinol.

A key finding of the investigation was that patient perceptions of the effectiveness and necessity of allopurinol strongly influenced their adherence during medication initiation, implementation, and discontinuation.

Patients who believed in the effectiveness and necessity of allopurinol were more likely to adhere to therapy, while those who had concerns or doubts about its efficacy or necessity were more likely to discontinue therapy.

Factors Impacting Allopurinol Adherence

Jane Spragg, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, and a team of investigators, stated that these results highlighted the significant barriers and facilitators to allopurinol adherence in patients with gout.

Patients who believed in the effectiveness and necessity of allopurinol, and had reminder systems in place, were more likely to adhere to the medication during the implementation phase. Barriers to adherence during the implementation phase included forgetfulness, gout flares, and limited feedback on the treatment’s effectiveness.

Many patients experienced barriers to allopurinol implementation, including concerns about the effectiveness of the medication and unsatisfactory interactions with healthcare professionals. Patients also discontinued allopurinol because they considered it unnecessary, believed their gout flares were not frequent enough to warrant long-term medication, or were concerned about taking long-term medication in general.

Discontinuation often coincided with patients experiencing gout flares while adhering to allopurinol and receiving suboptimal advice about gout management.

According to the findings, patients reported receiving accurate advice from HCPs and regular urate monitoring for feedback on allopurinol's effectiveness as potential strategies to improve adherence. They also saw self-monitoring of urate concentration as a strategy to promote adherence, as it would enable them to self-manage gout and make informed decisions about allopurinol therapy with their physician.

Research Sheds Light on Gout Treatment

Investigators conducted semi-structured interviews with 26 Australian patients diagnosed with gout who were currently on, or had previously, taken allopurinol. The interviews were performed by a single researcher and analyzed using a deductive and inductive approach.

The Necessity-Concerns Framework (NCF) was employed to structure the themes of facilitators and barriers to allopurinol adherence as well as strategies proposed to improve adherence.

Gout is a chronic and painful disease caused by the buildup of uric acid crystals in the joints. Allopurinol is a commonly prescribed medication to lower uric acid levels and prevent gout flares.

However, poor adherence to allopurinol is a major challenge in the management of this condition. Understanding the factors that mediate or hinder adherence to allopurinol across the different stages of medication adherence are necessary to improve adherence, including self-monitoring of urate concentration, according to the study.

In conclusion

The perceptions of patients on the effectiveness and necessity of allopurinol influenced intentional adherence during medication initiation, implementation, and discontinuation.

The data demonstrated the necessity of providing accurate medical advice and feedback on urate control to improve adherence to allopurinol. Patients also saw self-monitoring of urate concentration as a potential strategy to promote adherence.

Investigators believe that these findings provided valuable insights for healthcare professionals in developing strategies to improve adherence to allopurinol, as well as optimize the management of gout.

References:

1. Spragg, JCJ, Michael, TJF, Aslani, P, et al. Optimizing adherence to allopurinol for gout: patients' perspectives. Br J Clin Pharmacol. 2023; 1- 14. doi:10.1111/bcp.15657