Rheumatology International

, Volume 34, Issue 7, pp 963–970 | Cite as

Allopurinol use in a New Zealand population: prevalence and adherence

  • Simon HorsburghEmail author
  • Pauline Norris
  • Gordon Becket
  • Bruce Arroll
  • Peter Crampton
  • Jacqueline Cumming
  • Shirley Keown
  • Peter Herbison
Original Article


Allopurinol is effective for the control of gout and its long-term complications when taken consistently. There is evidence that adherence to allopurinol therapy varies across population groups. This may exacerbate differences in the burden of gout on population groups and needs to be accurately assessed. The aim of this study was to describe the prevalence of allopurinol use in a region of New Zealand using community pharmacy dispensing data and to examine the levels of suboptimal adherence in various population groups. Data from all community pharmacy dispensing databases in a New Zealand region were collected for a year covering 2005/2006 giving a near complete picture of dispensings to area residents. Prevalence of allopurinol use in the region by age, sex, ethnicity and socioeconomic position was calculated. Adherence was assessed using the medication possession ratio (MPR), with a MPR of 0.80 indicative of suboptimal adherence. Multiple logistic regression was used to explore variations in suboptimal adherence across population groups. A total of 953 people received allopurinol in the study year (prevalence 3 %). Prevalence was higher in males (6 %) than in females (1 %) and Māori (5 %) than non-Māori (3 %). The overall MPR during the study was 0.88, with 161 (22 %) of patients using allopurinol having suboptimal adherence. Non-Māori were 54 % less likely to have suboptimal allopurinol adherence compared to Māori (95 % CI 0.30–0.72, p = 0.001). These findings are consistent with those from other studies nationally and internationally and point to the important role for health professionals in improving patient adherence to an effective gout treatment.


Gout Allopurinol Adherence Pharmacoepidemiology 



This work is based on a study funded by the Health Research Council of New Zealand (Grant Number 07/139). The authors would like to thank the pharmacists and people of Gisborne for their advice and the use of their data, as well as the support of Ngati Porou Hauora and Turanga Health. The authors would also like to acknowledge the Local Advisory Committee to the project for their extremely useful insights and comments.

Supplementary material

296_2013_2935_MOESM1_ESM.docx (30 kb)
Supplementary material 1 (DOCX 29 kb)


  1. 1.
    Brook RA, Forsythe A, Smeeding JE, Lawrence Edwards N (2010) Chronic gout: epidemiology, disease progression, treatment and disease burden. Curr Med Res Opin 26:2813–2821. doi: 10.1185/03007995.2010.533647 PubMedCrossRefGoogle Scholar
  2. 2.
    Smith EUR, Díaz-Torné C, Perez-Ruiz F, March LM (2010) Epidemiology of gout: an update. Best Pract Res Clin Rheumatol 24:811–827. doi: 10.1016/j.berh.2010.10.004 PubMedCrossRefGoogle Scholar
  3. 3.
    Lindsay K, Gow P, Vanderpyl J et al (2011) The experience and impact of living with gout: a study of men with chronic gout using a qualitative grounded theory approach. J Clin Rheumatol 17:1–6. doi: 10.1097/RHU.0b013e318204a8f9 PubMedCrossRefGoogle Scholar
  4. 4.
    Winnard D, Kake T, Gow P et al (2008) Debunking the myths to provide 21st Century management of gout. N Z Med J 121:79–85PubMedGoogle Scholar
  5. 5.
    Martini N, Bryant L, Te Karu L et al (2012) Living with gout in New Zealand: an exploratory study into people’s knowledge about the disease and its treatment. J Clin Rheumatol 18:125–129. doi: 10.1097/RHU.0b013e31824e1f6f PubMedCrossRefGoogle Scholar
  6. 6.
    Kleinman NL, Brook RA, Patel PA et al (2007) The impact of gout on work absence and productivity. Value Heal 10:231–237. doi: 10.1111/j.1524-4733.2007.00173.x CrossRefGoogle Scholar
  7. 7.
    Winnard D, Wright C, Taylor WJ et al (2012) National prevalence of gout derived from administrative health data in Aotearoa New Zealand. Rheumatology 51:901–909. doi: 10.1093/rheumatology/ker361 PubMedCrossRefGoogle Scholar
  8. 8.
    Jackson G, Wright C, Thornley S et al (2012) Potential unmet need for gout diagnosis and treatment: capture-recapture analysis of a national administrative dataset. Rheumatology 51:1820–1824. doi: 10.1093/rheumatology/kes147 PubMedCrossRefGoogle Scholar
  9. 9.
    Trifirò G, Morabito P, Cavagna L et al (2012) Epidemiology of gout and hyperuricaemia in Italy during the years 2005–2009: a nationwide population-based study. Ann Rheum Dis. doi: 10.1136/annrheumdis-2011-201254 PubMedGoogle Scholar
  10. 10.
    Mikuls TR, Saag KG (2006) New insights into gout epidemiology. Curr Opin Rheumatol 18:199–203. doi: 10.1097/01.bor.0000209435.89720.7c PubMedCrossRefGoogle Scholar
  11. 11.
    Robinson PC, Taylor WJ, Merriman TR (2012) A systematic review of the prevalence of gout and hyperuricemia in Australia. Intern Med J 42:997–1007. doi: 10.1111/j.1445-5994.2012.02794.x PubMedGoogle Scholar
  12. 12.
    Rothenbacher D, Primatesta P, Ferreira A et al (2011) Frequency and risk factors of gout flares in a large population-based cohort of incident gout. Rheumatology 50:973–981. doi: 10.1093/rheumatology/keq363 PubMedCrossRefGoogle Scholar
  13. 13.
    Dalbeth N, So A (2010) Hyperuricaemia and gout: state of the art and future perspectives. Ann Rheum Dis 69:1738–1743. doi: 10.1136/ard.2010.136218 PubMedCrossRefGoogle Scholar
  14. 14.
    Schlesinger N, Dalbeth N, Perez-Ruiz F (2009) Gout–what are the treatment options? Expert Opin Pharmacother 10:1319–1328. doi: 10.1517/14656560902950742 PubMedCrossRefGoogle Scholar
  15. 15.
    Reach G (2011) Treatment adherence in patients with gout. Joint, Bone, Spine 78:456–459. doi: 10.1016/j.jbspin.2011.05.010 PubMedCrossRefGoogle Scholar
  16. 16.
    Briesacher BA, Andrade SE, Fouayzi H, Chan KA (2008) Comparison of drug adherence rates among patients with seven different medical conditions. Pharmacotherapy 28:437–443. doi: 10.1592/phco.28.4.437 PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Solomon DH, Avorn J, Levin R, Brookhart MA (2008) Uric acid lowering therapy: prescribing patterns in a large cohort of older adults. Ann Rheum Dis 67:609–613. doi: 10.1136/ard.2007.076182 PubMedCrossRefGoogle Scholar
  18. 18.
    Harrold LR, Andrade SE, Briesacher BA et al (2009) Adherence with urate-lowering therapies for the treatment of gout. Arthritis Res Ther 11:R46. doi: 10.1186/ar2659 PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Dunbar J, Dunning EJ, Dwyer K (1989) Compliance measurement with arthritis regimen. Arthritis Care Res (Hoboken) 2:A8–A16. doi: 10.1002/anr.1790020309 CrossRefGoogle Scholar
  20. 20.
    Horsburgh S, Malik M, Norris P et al (2009) Prescribing and dispensing data sources in New Zealand: their usage and future directions. School of Pharmacy, DunedinGoogle Scholar
  21. 21.
    Horsburgh S, Norris P, Becket G et al (2010) The equity in prescription medicines use study: using community pharmacy databases to study medicines utilisation. J Biomed Inform 43:982–987. doi: 10.1016/j.jbi.2010.08.004 PubMedCrossRefGoogle Scholar
  22. 22.
    Statistics New Zealand (2009) QuickStats about Gisborne District. Statistics New Zealand, WellingtonGoogle Scholar
  23. 23.
    Salmond C, Crampton P, Atkinson J (2007) NZDep2006 index of deprivation. Department of Public Health, University of Otago, WellingtonGoogle Scholar
  24. 24.
    Statistics New Zealand (2013) Urban/rural profile (experimental) classification categories. Accessed 13 Feb 2013
  25. 25.
    WHO Collaborating Centre for Drug Statistics Methodology (2007) Guidelines for ATC classification and DDD assignment. WHO Collaborating Centre for Drug Statistics Methodology, OsloGoogle Scholar
  26. 26.
    Apotex NZ Ltd (2011) New Zealand data sheet: Apo-Allopurinol. Apotex NZ Ltd, AucklandGoogle Scholar
  27. 27.
    Andrade SE, Kahler KH, Frech F, Chan KA (2006) Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf 15:565–574; discussion 575–577. doi:  10.1002/pds.1230 Google Scholar
  28. 28.
    Rothman KJ, Greenland S, Lash TL (2008) Modern epidemiology, 3rd edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  29. 29.
    R Core Team (2012) R: a language and environment for statistical computing. R Foundation for Statistical Computing, ViennaGoogle Scholar
  30. 30.
    Dalbeth N, House ME, Horne A et al (2012) The experience and impact of gout in Māori and Pacific people: a prospective observational study. Clin Rheumatol. doi: 10.1007/s10067-012-2110-5 PubMedGoogle Scholar
  31. 31.
    Harrold LR, Mazor KM, Velten S et al (2010) Patients and providers view gout differently: a qualitative study. Chronic Illn 6:263–271. doi: 10.1177/1742395310378761 PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Spencer K, Carr A, Doherty M (2012) Patient and provider barriers to effective management of gout in general practice: a qualitative study. Ann Rheum Dis 71:1490–1495. doi: 10.1136/annrheumdis-2011-200801 PubMedCrossRefGoogle Scholar
  33. 33.
    Ministry of Social Development (2010) The social report. Ministry of Social Development, WellingtonGoogle Scholar
  34. 34.
    Jatrana S, Crampton P, Norris P (2011) Ethnic differences in access to prescription medication because of cost in New Zealand. J Epidemiol Community Health 65:454–460. doi: 10.1136/jech.2009.099101 PubMedCrossRefGoogle Scholar
  35. 35.
    Jatrana S, Crampton P (2009) Primary health care in New Zealand: who has access? Health Policy (New York) 93:1–10. doi: 10.1016/j.healthpol.2009.05.006 CrossRefGoogle Scholar
  36. 36.
    Dalbeth N, Petrie KJ, House M et al (2011) Illness perceptions in patients with gout and the relationship with progression of musculoskeletal disability. Arthritis Care Res (Hoboken) 63:1605–1612. doi: 10.1002/acr.20570 CrossRefGoogle Scholar
  37. 37.
    Davis A (2012) Geographical access to medicines in Te Tairawhiti. University of OtagoGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Simon Horsburgh
    • 1
    Email author
  • Pauline Norris
    • 2
  • Gordon Becket
    • 3
  • Bruce Arroll
    • 4
  • Peter Crampton
    • 5
  • Jacqueline Cumming
    • 6
  • Shirley Keown
    • 2
  • Peter Herbison
    • 1
  1. 1.Department of Preventive and Social MedicineUniversity of OtagoDunedinNew Zealand
  2. 2.School of PharmacyUniversity of OtagoDunedinNew Zealand
  3. 3.Pharmacy and Pharmaceutical SciencesUniversity of Central LancashirePrestonUK
  4. 4.Department of General Practice and Primary Health Care, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
  5. 5.Division of Health SciencesUniversity of OtagoDunedinNew Zealand
  6. 6.Health Services Research CentreVictoria UniversityWellingtonNew Zealand

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