ULT Therapy Adherence High for Gout, Nonadherence Increases Flares

Till Uhlig, Dr. Med

Credit: REMEDY

A study has shown that while overall adherence to urate lowering therapy (ULT) was high, non-adherence was associated with more flares and less urate target achievement in people with gout. Younger people and people without European origin were less likely to adhere to ULT therapy.¹

“We lack knowledge on how self-reported adherence among gout patients treated with ULT associates with long-term disease outcomes of flare and successful achievement of the sUA target. Further, we know little about whether demographic or clinical baseline variables can predict long-term non-adherence, giving the clinical care provider useful information,” lead investigator Till Uhlig, Dr. Med, professor, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway, and University of Oslo, Faculty of Medicine, Norway, and colleagues wrote.¹

Uhlig and colleagues analyzed data from 163 patients in the NOR-Gout observational study that had a recent gout flare and serum urate levels over 360 µmol/L. Patients had a mean age of 56.2 years (standard deviation, 13.6), most were male (94.5%), and 17.2% had tophi. Participants attended tight-control visits for 1 year with escalating ULT using a treat-to-target strategy. Over 5-year follow-up, participants completed the Medication Adherence Report Scale (MARS-5) questionnaire (range 5-25) for assessing adherence. Investigators compared flares and serum UA target achievement for 5-year adherence to medication.¹

Investigators found that at 5 years, most patients used ULT (95.1%). Overall, MARS-5 adherence scores were high (median, 24; interquartile range, 22-25). Patients in the lowest MARS-5 quartile had, compared to the highest quartile,flares more often during the last year of follow-up (33.3% vs. 9.5%, P =.004), and reached the 5-year serum urate treatment target less frequently (45.2% vs. 87.5%, P <.001).¹

They found that baseline lower age (odds ratio [OR}, 0.56 [95%CI, 0.39-0.79]), non-European origin (OR, 0.22 [95%CI, 0.06-0.80]), lower SF-36 mental health scores (OR, 0.94 [95%CI, 0.91-0.98]) and less joint pain during last flare (OR, 0.73 [95%CI, 0.58-0.92]) were independent risk factors for non-adherence to medication.¹

“In summary, adherence to medication was in our study high after 5 years, and nonadherence was related to poor gout outcomes. Findings underscore that caregivers should address variables associated with non-adherence early during ULT and provide additional care to support adherence in those at risk of non-adherence,” Uhlig and colleagues concluded.¹

Uhlig and colleagues noted that several limitations of their study included the intensive ULT treatment that participants received, the nature of the patient-reported gout flares and adherence, and the observational design of the study not allowing for causal inference.

The importance of conducting new and supporting research into gout will only rise as the prevalence of gout increases. Recent estimates have suggested that the number of people with gout will increase by more than 70% by the year 2050, with the increase largely driven by population growth and aging.²

REFERENCES

1. Uhlig T, Karoliussen LF, Sexton J, et al.Non-adherence to urate lowering therapy in gout after 5 years is related to poor outcomes—results from the NOR-Gout study, Rheumatology. Published online September 18,2024;keae514. Doi: 10.1093/rheumatology/keae514

2. GBD 2021 Gout Collaborators. Global, regional, and national burden of gout, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2024; 6(8): e507-e517