Long-term persistence and adherence on urate-lowering treatment can be maintained in primary care—5-year follow-up of a proof-of-concept study

Abstract

Objectives. To evaluate the persistence and adherence on urate-lowering treatment (ULT) in primary care 5 years after an initial nurse-led treatment of gout.

Methods. One hundred gout patients initiated on up-titrated ULT between March and July 2010 were sent a questionnaire that elicited information on current ULT, reasons for discontinuation of ULT if applicable, medication adherence and generic and disease-specific quality-of-life measures in 2015. They were invited for one visit at which height and weight were measured and blood was collected for serum uric acid measurement.

Results. Seventy-five patients, mean age 68.13 years (s.d. 10.07) and disease duration 19.44 years (s.d. 13), returned completed questionnaires. The 5-year persistence on ULT was 90.7% (95% CI 81.4, 91.6) and 85.3% of responders self-reported taking ULT ⩾6 days/week. Of the 65 patients who attended the study visit, the mean serum uric acid was 292.8 μmol/l (s.d. 97.2).

Conclusion. An initial treatment that includes individualized patient education and involvement in treatment decisions results in excellent adherence and persistence on ULT >4 years after the responsibility of treatment is taken over by the patient’s general practitioner, suggesting that this model of gout management should be widely adopted.

gout, urate lowering treatment, persistence, adherence