Adherence and Treat-to-Target Benchmarks in Older Adults With Gout Initiating Urate-Lowering Therapy in Ontario, Canada: A Population-Based Study

IF 3.7 2区 医学 Q1 RHEUMATOLOGY Arthritis Care & Research Pub Date : 2024-06-03 DOI:10.1002/acr.25380
Timothy S. H. Kwok, Bindee Kuriya, Gillian Hawker, Lihi Eder, Ping Li, Gregory Choy, Jessica Widdifield
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Abstract

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

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加拿大安大略省接受尿酸盐降压疗法的痛风老年患者的依从性和治疗目标基准:基于人群的研究
目标:我们试图评估开始使用 ULT 的老年痛风患者的降尿酸治疗(ULT)依从性和治疗目标(T2T)血清尿酸(SUA)水平:我们在加拿大安大略省开展了一项基于人群的回顾性队列研究,研究对象是 2010 年至 2019 年间新配发 ULT 的年龄≥66 岁的痛风患者。我们将成功进行 T2T 的患者定义为达到 SUA 水平的患者:在 44,438 名患者(平均(标清)年龄为 76.0±7.3 岁;64.4% 为男性)中,30,057 名患者(67.6%)完成了≥1 次 SUA 测试。总体而言,52.3%的患者在12个月内达到了SUA目标,从2010年的45.2%提高到2019年的61.2%(p < 0.0001)。超短波治疗依从性总体为 55.3%,并逐年提高。与实现 T2T 相关的关键因素包括非布司他的使用(OR 11.40,95% CI 5.10-25.43)(仅有 88 名患者获得配药)、超短波治疗的依从性(OR 5.17,95% CI 4.89-5.47)、开始使用别嘌醇(OR 5.17,95% CI 4.89-5.47)。47)、别嘌呤醇起始剂量大于 50 毫克(OR 2.53,95% CI:2.14-2.99)、秋水仙碱/口服皮质类固醇联合处方(OR 1.24,95% CI:1.14-1.34)以及风湿免疫科医生开具的 ULT 处方:结论:只有 52.3% 的患者在开始使用超短波治疗一年内达到了最佳 SUA 水平。超短波治疗的依从性不理想,但随着时间的推移有所改善。坚持超短波治疗和较高的别嘌呤醇起始剂量与达到目标 SUA 水平的关系最为密切。这项研究强调了痛风治疗中有待改进的地方,以及解决治疗差距的潜在策略。
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来源期刊
CiteScore
9.40
自引率
6.40%
发文量
368
审稿时长
3-6 weeks
期刊介绍: Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals (a division of the College), is a peer-reviewed publication that publishes original research, review articles, and editorials that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with rheumatic diseases, major topics are evidence-based practice studies, clinical problems, practice guidelines, educational, social, and public health issues, health economics, health care policy, and future trends in rheumatology practice.
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