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Adherence and treat to target benchmarks in older adults with gout initiating urate lowering therapy in Ontario, Canada: a population-based study


Objectives — We sought to evaluate urate lowering therapy (ULT) adherence and treatment-to-target (T2T) serum uric acid (SUA) levels amongst 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. Multi-level 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 use (OR 11.40, 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 corticosteroids co-prescription (OR 1.24, 95% CI: 1.14-1.34) and ULT prescription from a rheumatologist.

Conclusions — Only 52.3% of patients achieved an optimal SUA level within 1 year of ULT initiation. ULT adherence was suboptimal though 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.



Kwok TSH, Kuriya B, Hawker G, Eder L, Li P, Choy G, Widdifield J. Arthritis Care Res. 2024; Jun 3 [Epub ahead of print].

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