Long-term persistence and adherence on uratelowering 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 mmol/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.