Adherence and Outcomes with Urate-Lowering Therapy: A Site-Randomized Trial - 01/03/19
, T. Craig Cheetham, PharmD, MS b, c, Gerald D. Levy, MD b, Nazia Rashid, PharmD, MS d, Artak Kerimian, PharmD b, Kimberly J. Low, PharmD b, Brian W. Coburn, MD, PhD a, David T. Redden, PhD e, Kenneth G. Saag, MD, MSc f, P. Jeffrey Foster, MPH f, Lang Chen, PhD f, Jeffrey R. Curtis, MD, MPH fAbstract |
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.
El texto completo de este artículo está disponible en PDF.Keywords : Adherence, Allopurinol, Gout, Pharmacist, Pragmatic trial, Randomized trial, Serum urate
Esquema
| Funding: This work is funded by the National Institutes of Health (NIH) / National Institute of Arthritis and Musculoskeletal and Skin Diseases (P50AR060772). TRM receives research support from NIH/National Institute of General Medical Sciences (U54GM115458) and the National Institute on Alcohol Abuse and Alcoholism (R25AA020818). |
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| Conflicts of Interest: The authors have no conflicts of interest to declare. |
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| Authorship: All authors confirm equal access to data and a role in writing the manuscript. |
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| Trial Registration: NCT 02790463 www.ClinicalTrials.gov |
Vol 132 - N° 3
P. 354-361 - mars 2019 Regresar al número
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