Reasons for discontinuing urate-lowering treatment in community-dwelling adults with gout: results of a primary care-based cross-sectional study

OBJECTIVES: The aim was to examine the prevalence of urate-lowering treatment (ULT) in community-dwelling adults with gout and the reasons for drug discontinuation. METHODS: Adults with gout living in the East Midlands, UK, were mailed a postal questionnaire by their general practice surgery. It enquired about demographic details, co-morbidities, number of gout flares in the previous 12 months, current ULT and the reasons for discontinuing ULT if applicable. The number (percentage), median [interquartile range (IQR)] and mean (s.d.) were used for descriptive purposes. The Mann–Whitney U test and χ(2) test were used for univariate analyses. STATA v.16 was used for data analysis. Statistical significance was set at P < 0.05. RESULTS: Data for 634 gout patients [89.3% men, mean (s.d.) age 64.77 (12.74) years)] were included. Of the respondents, 59.8% self-reported taking ULT currently, with the vast majority (95.6%) taking allopurinol. Participants self-reporting current ULT experienced fewer gout flares in the previous 12 months than those who did not self-report current ULT [median (IQR) 0 (0–2) and 1 (0–3), respectively, P < 0.05]. One hundred and seven participants (16.9%) self-reported ULT discontinuation previously. The most commonly cited reasons for this were side-effects (29.7%), being fed up with taking tablets (19.8%) and lack of benefit from treatment or ULT-induced gout flares (19.8%). Treatment being stopped by the general practitioner without a clear reason known to the participant (15.8%) was another common report. CONCLUSION: This study identified patient-, physician- and treatment-related barriers to long-term ULT. These should be addressed when initiating ULT and during regular review. Further research is required to confirm these findings in other populations.