Implication of Character Traits in Adherence to Treatment in People with Gout: A Reason for Considering Nonadherence As a Syndrome

Abstract

Background: Various aspects of nonadherence to therapy (including medication and lifestyle nonadherence) often appear together. Here we report the association between treatment adherence in gout and the two character traits of patience and obedience, which may explain this observation. Methods: Data were collected from a cross-sectional study conducted in a French cohort of 1,441 adult patients. Patience was assessed using the choice between receiving €1,500 in 1 year or €500 immediately. Obedience was evaluated with a single question assessing the use of the seatbelt in the rear seat of a car. Adherence to recommendations for medication, beverage, food and physical activity and smoking status were assessed using self-report questionnaires. Findings: Patience and obedience were strong determinants of adherence to medication in multivariate analysis (OR 2.056, 95% CI [1.414-2.989], P< 0.001; OR 1.844, 95% CI [1.273-2.671], P=0.001). In univariate analysis, adherence to medication was also associated with compliance with dietary directives (P<0.001), lower alcohol consumption on an ordinary day (P< 0.001), never consuming soda (P<0.001) or beer (P<0.001), practice of physical activity (P=0.002), being a nonsmoker (P<0.001) and monitoring serum levels of uric acid regularly (P=0.011). Multiple-correspondence analysis illustrated the associations of these different aspects of adherence (medication, diet and exercise, smoking status and monitoring of disease control) with patience and obedience. Finally, we observed a link between patience and obedience (P< 0.001). Interpretation: Character traits, which shape preferences, may cause the clustering of different aspects of nonadherence in the form of a syndrome, elucidating the still enigmatic link between nonadherence to placebo and mortality in randomised clinical trials. This concept may also explain, at least in part, the difficulty of improving adherence to long-term therapies and may lead to ethical issues. Funding Statement: The study was sponsored by Menarini. Euraxi Pharma was the contract research organisation appointed by the sponsor to conduct this study together with the academic authors GR, LM and RMF. Declaration of Interests: GR, LM and RMF received fees from Menarini to design the study and to analyse the results. IEB and PM are Menarini employees. GC is an employee of Capionis. Ethics Approval Statement: Formal approval from the Advisory Committee on Information Processing in Material Research in the Field of Health (CCTIRS) was obtained. Before patient inclusion, the purpose and objectives of the study were explained orally and in writing to potential subjects, and oral informed consent was obtained. The French Commission Nationale Informatique et Libertes gave its approval.