For a study, researchers sought to determine the reasons patients provide for not taking allopurinol and to see if there were any differences in intentional nonadherence between patients who did and did not reach serum urate (SU) levels at the treatment target.

About 69 men completed the Intentional Non-Adherence Scale (INAS) with gout who attended rheumatology clinics and were all administered allopurinol for 6 months. The forms of intentional nonadherence differed between individuals who did and did not attain SU at the treatment target (<0.36 mmol/L, 6 mg/dL).

The most often stated reasons for not using urate-lowering therapies (ULT) were that individuals wished to live a normal life (23%) or think of themselves as healthy again (20%). Patients also stated that they did not take allopurinol to see if they actually required it (22%). Participants with SU levels above the goal endorsed considerably more INAS items as reasons for not taking their prescription, had more medicine-related anxieties, and were more likely to blame nonadherence on Testing treatment. Participants who were younger, and unmarried, cited greater reasons for not taking allopurinol.

The main reasons for the patient’s refusal to take allopurinol are a wish to live a normal life and a strategy of trying the medication to see whether they might lessen the dose without experiencing effects. The results provided some potentially modifiable targets for adherence interventions and some recommendations to clinicians about how to reframe ULT for patients in order to improve adherence.

Reference: jrheum.org/content/49/6/622