Factors Influencing Urate-Lowering Therapy Prescriptions in Gout Patients: A Retrospective National Cohort Study

OBJECTIVES: Acute gout flares significantly impact patients’ quality of life, making their prevention a primary goal in gout management, with urate-lowering therapy (ULT) playing a crucial role. This study analyzed ULT prescription rates among gout patients recommended for ULT and identified influencing factors.

METHODS: This retrospective study utilized data from 2007 to 2018 from the National Health Insurance sample cohort, focusing on patients diagnosed with gout (ICD-10 code: M10) at least once each in 2016 and 2017. We examined the proportion of gout patients receiving ULT among those who met specific ULT prescription criteria: criterion 1, having 2 gout flares per year; criterion 2, a history of urolithiasis; criterion 3, presence of comorbidities such as renal impairment, hypertension, ischemic heart disease, or heart failure; and criterion 4, age <40 years. Logistic regression analysis was performed to identify factors associated with ULT prescription.

RESULTS: Out of 6,082 gout patients, 4,566 (75.1%) met at least one criterion, with the highest proportion meeting criterion 3 (50.6%), followed by criterion 4 (18.4%), criterion 1 (16.0%), and criterion 2 (11.6%). Among those meeting any criterion, 3,291 (72.1%) were prescribed ULT. Interestingly, ULT prescriptions did not increase linearly with the number of criteria met. Logistic regression analysis identified several factors significantly associated with the ULT prescription: meeting criterion 3 (odds ratio [OR]: 1.351, 95% confidence interval [CI] 1.098-1.662), being male (OR: 1.687, 95% CI: 1.294-2.2), having a higher income (OR: 1.377-1.524 for upper income decile groups), receiving gout care at hospitals vs. clinics (OR: 1.295, 95% CI: 1.042-1.609), and receiving gout care from internal medicine clinicians vs. orthopedics (OR: 1.352, 95% CI: 1.14-1.604).

CONCLUSIONS: Our finding that only criterion 3 significantly increases the likelihood of ULT prescription suggests that more attention should be given to patients meeting criteria 1, 2, and 4.