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Persistence with urate‐lowering therapy in Australia: A longitudinal analysis of allopurinol prescriptions

Aim Gout is the most common form of inflammatory arthritis in men. Despite the availability of effective urate‐lowering therapies (ULT), the management of gout is suboptimal due to poor persistence with ULT. This study examined national prescribing patterns of ULT to determine persistence with allop...

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Published in:British journal of clinical pharmacology 2022-11, Vol.88 (11), p.4894-4901
Main Authors: Coleshill, Matthew J., Day, Richard O., Tam, Karson, Kouhkamari, Mahsa, Caillet, Vincent, Aung, Eindra, Kannangara, Diluk R. W., Cronin, Peter, Rodgers, Anthony, Stocker, Sophie L.
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container_end_page 4901
container_issue 11
container_start_page 4894
container_title British journal of clinical pharmacology
container_volume 88
creator Coleshill, Matthew J.
Day, Richard O.
Tam, Karson
Kouhkamari, Mahsa
Caillet, Vincent
Aung, Eindra
Kannangara, Diluk R. W.
Cronin, Peter
Rodgers, Anthony
Stocker, Sophie L.
description Aim Gout is the most common form of inflammatory arthritis in men. Despite the availability of effective urate‐lowering therapies (ULT), the management of gout is suboptimal due to poor persistence with ULT. This study examined national prescribing patterns of ULT to determine persistence with allopurinol in Australia. Methods A 10% sample of the Australian Pharmaceutical Benefits Scheme dispensing claims database was used to identify individuals initiated on allopurinol between April 2014 and December 2019. The number of allopurinol scripts dispensed was used to estimate persistence with allopurinol. Persistence was defined as the number of months from initiation until discontinuation (last prescription with no further scripts acquired for a period thereafter). Kaplan‐Meier curves were used to examine persistence, while Cox regression analysis was used to examine the influence of gender, concomitant colchicine and age. Results The largest drop in persistence occurred immediately after initiation, with 34% of patients discontinuing allopurinol 300‐mg therapy in the first month. Median persistence with allopurinol 300 mg was 5 months (95% confidence interval 4.76‐5.24), with around 63% of individuals not persisting with this therapy for more than 12 months. Concomitant prescription of colchicine on the day of allopurinol initiation only occurred in 7% of allopurinol initiations. No increase in persistence was observed for those co‐prescribed colchicine. Conclusion Persistence with allopurinol was poor. More effective methods targeting prescribers, patients and systems are required to promote persistence with allopurinol. Improving persistence to allopurinol is an important public health goal given the proven potential of this medication to eliminate gout.
doi_str_mv 10.1111/bcp.15435
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W. ; Cronin, Peter ; Rodgers, Anthony ; Stocker, Sophie L.</creator><creatorcontrib>Coleshill, Matthew J. ; Day, Richard O. ; Tam, Karson ; Kouhkamari, Mahsa ; Caillet, Vincent ; Aung, Eindra ; Kannangara, Diluk R. W. ; Cronin, Peter ; Rodgers, Anthony ; Stocker, Sophie L.</creatorcontrib><description>Aim Gout is the most common form of inflammatory arthritis in men. Despite the availability of effective urate‐lowering therapies (ULT), the management of gout is suboptimal due to poor persistence with ULT. This study examined national prescribing patterns of ULT to determine persistence with allopurinol in Australia. Methods A 10% sample of the Australian Pharmaceutical Benefits Scheme dispensing claims database was used to identify individuals initiated on allopurinol between April 2014 and December 2019. The number of allopurinol scripts dispensed was used to estimate persistence with allopurinol. Persistence was defined as the number of months from initiation until discontinuation (last prescription with no further scripts acquired for a period thereafter). Kaplan‐Meier curves were used to examine persistence, while Cox regression analysis was used to examine the influence of gender, concomitant colchicine and age. Results The largest drop in persistence occurred immediately after initiation, with 34% of patients discontinuing allopurinol 300‐mg therapy in the first month. Median persistence with allopurinol 300 mg was 5 months (95% confidence interval 4.76‐5.24), with around 63% of individuals not persisting with this therapy for more than 12 months. Concomitant prescription of colchicine on the day of allopurinol initiation only occurred in 7% of allopurinol initiations. No increase in persistence was observed for those co‐prescribed colchicine. Conclusion Persistence with allopurinol was poor. More effective methods targeting prescribers, patients and systems are required to promote persistence with allopurinol. Improving persistence to allopurinol is an important public health goal given the proven potential of this medication to eliminate gout.</description><identifier>ISSN: 0306-5251</identifier><identifier>EISSN: 1365-2125</identifier><identifier>DOI: 10.1111/bcp.15435</identifier><identifier>PMID: 35675118</identifier><language>eng</language><publisher>England: John Wiley and Sons Inc</publisher><subject>allopurinol ; Allopurinol - therapeutic use ; Australia - epidemiology ; colchicine ; Colchicine - therapeutic use ; gout ; Gout - drug therapy ; Gout Suppressants - therapeutic use ; Humans ; Male ; Medication Adherence ; medication persistence ; Original ; Pharmaceutical Preparations ; Prescriptions ; urate‐lowering therapy ; Uric Acid</subject><ispartof>British journal of clinical pharmacology, 2022-11, Vol.88 (11), p.4894-4901</ispartof><rights>2022 The Authors. published by John Wiley &amp; Sons Ltd on behalf of British Pharmacological Society.</rights><rights>2022 The Authors. British Journal of Clinical Pharmacology published by John Wiley &amp; Sons Ltd on behalf of British Pharmacological Society.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4155-14a7bd40239388d165a8401192233db509357a0f0070d0f3edd0fdce7619c9db3</citedby><cites>FETCH-LOGICAL-c4155-14a7bd40239388d165a8401192233db509357a0f0070d0f3edd0fdce7619c9db3</cites><orcidid>0000-0002-6045-6937 ; 0000-0003-1055-5897 ; 0000-0001-7297-5593 ; 0000-0003-1282-1896 ; 0000-0003-1906-1893 ; 0000-0003-1463-7320 ; 0000-0002-2114-587X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35675118$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Coleshill, Matthew J.</creatorcontrib><creatorcontrib>Day, Richard O.</creatorcontrib><creatorcontrib>Tam, Karson</creatorcontrib><creatorcontrib>Kouhkamari, Mahsa</creatorcontrib><creatorcontrib>Caillet, Vincent</creatorcontrib><creatorcontrib>Aung, Eindra</creatorcontrib><creatorcontrib>Kannangara, Diluk R. W.</creatorcontrib><creatorcontrib>Cronin, Peter</creatorcontrib><creatorcontrib>Rodgers, Anthony</creatorcontrib><creatorcontrib>Stocker, Sophie L.</creatorcontrib><title>Persistence with urate‐lowering therapy in Australia: A longitudinal analysis of allopurinol prescriptions</title><title>British journal of clinical pharmacology</title><addtitle>Br J Clin Pharmacol</addtitle><description>Aim Gout is the most common form of inflammatory arthritis in men. Despite the availability of effective urate‐lowering therapies (ULT), the management of gout is suboptimal due to poor persistence with ULT. This study examined national prescribing patterns of ULT to determine persistence with allopurinol in Australia. Methods A 10% sample of the Australian Pharmaceutical Benefits Scheme dispensing claims database was used to identify individuals initiated on allopurinol between April 2014 and December 2019. The number of allopurinol scripts dispensed was used to estimate persistence with allopurinol. Persistence was defined as the number of months from initiation until discontinuation (last prescription with no further scripts acquired for a period thereafter). Kaplan‐Meier curves were used to examine persistence, while Cox regression analysis was used to examine the influence of gender, concomitant colchicine and age. Results The largest drop in persistence occurred immediately after initiation, with 34% of patients discontinuing allopurinol 300‐mg therapy in the first month. Median persistence with allopurinol 300 mg was 5 months (95% confidence interval 4.76‐5.24), with around 63% of individuals not persisting with this therapy for more than 12 months. Concomitant prescription of colchicine on the day of allopurinol initiation only occurred in 7% of allopurinol initiations. No increase in persistence was observed for those co‐prescribed colchicine. Conclusion Persistence with allopurinol was poor. More effective methods targeting prescribers, patients and systems are required to promote persistence with allopurinol. Improving persistence to allopurinol is an important public health goal given the proven potential of this medication to eliminate gout.</description><subject>allopurinol</subject><subject>Allopurinol - therapeutic use</subject><subject>Australia - epidemiology</subject><subject>colchicine</subject><subject>Colchicine - therapeutic use</subject><subject>gout</subject><subject>Gout - drug therapy</subject><subject>Gout Suppressants - therapeutic use</subject><subject>Humans</subject><subject>Male</subject><subject>Medication Adherence</subject><subject>medication persistence</subject><subject>Original</subject><subject>Pharmaceutical Preparations</subject><subject>Prescriptions</subject><subject>urate‐lowering therapy</subject><subject>Uric Acid</subject><issn>0306-5251</issn><issn>1365-2125</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNp1kL9OwzAQxi0EoqUw8ALIK0NaO46TmgGpVPyTKtEBZsuJndbIxJGdUGXjEXhGngSXQAUDN9wN33e_O30AnGI0xqEmeVGPMU0I3QNDTFIaxTim-2CICEojGlM8AEfePyOECU7pIRgQmmYU4-kQmKVyXvtGVYWCG92sYetEoz7e3o3dKKerFWzWyom6g7qCs9Y3ThgtLuAMGlutdNNKXQkDRWhdAEFbQmGMrduwaw2snfKF03WjbeWPwUEpjFcn33MEnm6uH-d30eLh9n4-W0RFgimNcCKyXCYoJoxMpzK8LKYJwpjFMSEyp4gRmglUIpQhiUqiZOiyUFmKWcFkTkbgsufWbf6iglJtv-a10y_CddwKzf8qlV7zlX3lLGOUxWkAnPeAwlnvnSp3uxjxbeQ8RM6_Ig_es9_Hds6fjINh0hs22qjufxK_mi975CeRP49c</recordid><startdate>202211</startdate><enddate>202211</enddate><creator>Coleshill, Matthew J.</creator><creator>Day, Richard O.</creator><creator>Tam, Karson</creator><creator>Kouhkamari, Mahsa</creator><creator>Caillet, Vincent</creator><creator>Aung, Eindra</creator><creator>Kannangara, Diluk R. 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W. ; Cronin, Peter ; Rodgers, Anthony ; Stocker, Sophie L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4155-14a7bd40239388d165a8401192233db509357a0f0070d0f3edd0fdce7619c9db3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>allopurinol</topic><topic>Allopurinol - therapeutic use</topic><topic>Australia - epidemiology</topic><topic>colchicine</topic><topic>Colchicine - therapeutic use</topic><topic>gout</topic><topic>Gout - drug therapy</topic><topic>Gout Suppressants - therapeutic use</topic><topic>Humans</topic><topic>Male</topic><topic>Medication Adherence</topic><topic>medication persistence</topic><topic>Original</topic><topic>Pharmaceutical Preparations</topic><topic>Prescriptions</topic><topic>urate‐lowering therapy</topic><topic>Uric Acid</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Coleshill, Matthew J.</creatorcontrib><creatorcontrib>Day, Richard O.</creatorcontrib><creatorcontrib>Tam, Karson</creatorcontrib><creatorcontrib>Kouhkamari, Mahsa</creatorcontrib><creatorcontrib>Caillet, Vincent</creatorcontrib><creatorcontrib>Aung, Eindra</creatorcontrib><creatorcontrib>Kannangara, Diluk R. 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W.</au><au>Cronin, Peter</au><au>Rodgers, Anthony</au><au>Stocker, Sophie L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Persistence with urate‐lowering therapy in Australia: A longitudinal analysis of allopurinol prescriptions</atitle><jtitle>British journal of clinical pharmacology</jtitle><addtitle>Br J Clin Pharmacol</addtitle><date>2022-11</date><risdate>2022</risdate><volume>88</volume><issue>11</issue><spage>4894</spage><epage>4901</epage><pages>4894-4901</pages><issn>0306-5251</issn><eissn>1365-2125</eissn><abstract>Aim Gout is the most common form of inflammatory arthritis in men. Despite the availability of effective urate‐lowering therapies (ULT), the management of gout is suboptimal due to poor persistence with ULT. This study examined national prescribing patterns of ULT to determine persistence with allopurinol in Australia. Methods A 10% sample of the Australian Pharmaceutical Benefits Scheme dispensing claims database was used to identify individuals initiated on allopurinol between April 2014 and December 2019. The number of allopurinol scripts dispensed was used to estimate persistence with allopurinol. Persistence was defined as the number of months from initiation until discontinuation (last prescription with no further scripts acquired for a period thereafter). Kaplan‐Meier curves were used to examine persistence, while Cox regression analysis was used to examine the influence of gender, concomitant colchicine and age. Results The largest drop in persistence occurred immediately after initiation, with 34% of patients discontinuing allopurinol 300‐mg therapy in the first month. Median persistence with allopurinol 300 mg was 5 months (95% confidence interval 4.76‐5.24), with around 63% of individuals not persisting with this therapy for more than 12 months. Concomitant prescription of colchicine on the day of allopurinol initiation only occurred in 7% of allopurinol initiations. No increase in persistence was observed for those co‐prescribed colchicine. Conclusion Persistence with allopurinol was poor. More effective methods targeting prescribers, patients and systems are required to promote persistence with allopurinol. Improving persistence to allopurinol is an important public health goal given the proven potential of this medication to eliminate gout.</abstract><cop>England</cop><pub>John Wiley and Sons Inc</pub><pmid>35675118</pmid><doi>10.1111/bcp.15435</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-6045-6937</orcidid><orcidid>https://orcid.org/0000-0003-1055-5897</orcidid><orcidid>https://orcid.org/0000-0001-7297-5593</orcidid><orcidid>https://orcid.org/0000-0003-1282-1896</orcidid><orcidid>https://orcid.org/0000-0003-1906-1893</orcidid><orcidid>https://orcid.org/0000-0003-1463-7320</orcidid><orcidid>https://orcid.org/0000-0002-2114-587X</orcidid><oa>free_for_read</oa></addata></record>
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subjects allopurinol
Allopurinol - therapeutic use
Australia - epidemiology
colchicine
Colchicine - therapeutic use
gout
Gout - drug therapy
Gout Suppressants - therapeutic use
Humans
Male
Medication Adherence
medication persistence
Original
Pharmaceutical Preparations
Prescriptions
urate‐lowering therapy
Uric Acid
title Persistence with urate‐lowering therapy in Australia: A longitudinal analysis of allopurinol prescriptions
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