Adherence and Outcomes with Urate-Lowering Therapy: A Site-Randomized Trial

Ted R Mikuls, T. Craig Cheetham, Gerald D. Levy, Nazia Rashid, Artak Kerimian, Kimberly J. Low, Brian W. Coburn, David T. Redden, Kenneth G. Saag, P. Jeffrey Foster, Lang Chen, Jeffrey R. Curtis

Research output: Contribution to journalArticle

Abstract

Purpose: The purpose of this study was to test a pharmacist-led intervention to improve gout treatment adherence and outcomes. Methods: We conducted a site-randomized trial (n=1463 patients) comparing a 1-year, pharmacist-led intervention to usual care in patients with gout initiating allopurinol. The intervention was delivered primarily through automated telephone technology. Co-primary outcomes were the proportion of patients adherent (proportion of days covered ≥0.8) and achieving a serum urate <6.0 mg/dl at 1 year. Outcomes were reassessed at year 2. Results: Patients who underwent intervention were more likely than patients of usual care to be adherent (50% vs 37%; odds ratio [OR] 1.68; 95% confidence interval [CI] 1.30, 2.17) and reach serum urate goal (30% vs 15%; OR 2.37; 95% CI 1.83, 3.05). In the second year (1 year after the intervention ended), differences were attenuated, remaining significant for urate goal but not for adherence. The intervention was associated with a 6%-16% lower gout flare rate during year 2, but the differences did not reach statistical significance. Conclusions: A pharmacist-led intervention incorporating automated telephone technology improved adherence and serum urate goal in patients with gout initiating allopurinol. Although this light-touch, low-tech intervention was efficacious, additional efforts are needed to enhance patient engagement in gout management and ultimately to improve outcomes.

Original languageEnglish (US)
JournalAmerican Journal of Medicine
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Gout
Uric Acid
Pharmacists
Allopurinol
Telephone
Patient Care
Serum
Odds Ratio
Confidence Intervals
Technology
Therapeutics
Patient Participation
Touch

Keywords

  • Adherence
  • Allopurinol
  • Gout
  • Pharmacist
  • Pragmatic trial
  • Randomized trial
  • Serum urate

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Mikuls, T. R., Cheetham, T. C., Levy, G. D., Rashid, N., Kerimian, A., Low, K. J., ... R. Curtis, J. (Accepted/In press). Adherence and Outcomes with Urate-Lowering Therapy: A Site-Randomized Trial. American Journal of Medicine. https://doi.org/10.1016/j.amjmed.2018.11.011

Adherence and Outcomes with Urate-Lowering Therapy : A Site-Randomized Trial. / Mikuls, Ted R; Cheetham, T. Craig; Levy, Gerald D.; Rashid, Nazia; Kerimian, Artak; Low, Kimberly J.; Coburn, Brian W.; Redden, David T.; Saag, Kenneth G.; Foster, P. Jeffrey; Chen, Lang; R. Curtis, Jeffrey.

In: American Journal of Medicine, 01.01.2019.

Research output: Contribution to journalArticle

Mikuls, TR, Cheetham, TC, Levy, GD, Rashid, N, Kerimian, A, Low, KJ, Coburn, BW, Redden, DT, Saag, KG, Foster, PJ, Chen, L & R. Curtis, J 2019, 'Adherence and Outcomes with Urate-Lowering Therapy: A Site-Randomized Trial' American Journal of Medicine. https://doi.org/10.1016/j.amjmed.2018.11.011
Mikuls, Ted R ; Cheetham, T. Craig ; Levy, Gerald D. ; Rashid, Nazia ; Kerimian, Artak ; Low, Kimberly J. ; Coburn, Brian W. ; Redden, David T. ; Saag, Kenneth G. ; Foster, P. Jeffrey ; Chen, Lang ; R. Curtis, Jeffrey. / Adherence and Outcomes with Urate-Lowering Therapy : A Site-Randomized Trial. In: American Journal of Medicine. 2019.
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