Why Half of Gout Patients Don't Take Their Meds

De Vera MA, Marcotte G, Rai S, et al. Medication adherence in gout: A systematic review.Arthritis Care and Research. (2014) Accepted manuscript [e-pub 1 APR 2014] DOI: 10.1002/acr.22336

Drug adherence may be worse in gout than in any other chronic disease, with less than half of patients sticking with their urate-lowering medications, according to a recent systematic review from Canada.

The review of 16 studies, most from large electronic medication databases, finds that the factors associated with non-adherence include younger age, gout flare before testing of serum uric acid (SUA) levels, and no previous diagnosis of tophaceous gout.

The most adherent gout patients tended to be older, hypertensive, with previously diagnosed (as opposed to newly-diagnosed) gout.

Not surprisingly, gout patients who stayed on their meds were more likely to have SUA levels below 6 mg/dL. SUA higher than that target level are associated with a threefold risk of acute flare.

Researchers speculate that patients with a prior diagnosis may be more motivated to stay on drugs like allopurinol because of their experience with gout attacks, while the newly-diagnosed may feel therapy did not prevent flares.

In a formal study setting, participants gave excuses such as “forgetting” or “feeling better,” while in real-life care patients said they “did not want to take long-term medication,” they were “unaware” they had to take it every day, or they “simply forgot.”

However, some studies did find that up to half of such patients eventually refilled their prescriptions.

Nonadherence rates were as low as 10% and high as 46%, among the worst compared to seven other chronic diseases surveyed.

The researchers say their findings point up the need to develop effective ways of improving compliance in gout.