Long-Term Adherence to Urate-Lowering Therapy in Gout: A Glass Half Empty or a Glass Half Full?
Bibliographic record
Abstract
Characterized by flares of intensely painful arthritis, gout is the most common type of inflammatory arthritis worldwide. National prevalence estimates approaching 4% translate to more than 9 million persons living with gout in the United States alone, with worldwide estimates reaching as high as 10% in some regions.1,2 The painful nature of gout flare often leads patients to seek acute care, which, in turn, results in increased healthcare costs in addition to decreased work attendance and productivity.3,4 Central to disease pathogenesis, hyperuricemia is a necessary (albeit insufficient) risk factor in gout development. Several highly effective and well-tolerated urate-lowering therapies (ULTs; eg, allopurinol, febuxostat, probenecid) are available for use and collectively provide the real potential of reducing or even preventing flares. Allopurinol, the most commonly used ULTs, is relatively inexpensive, retailing at approximately $20 to $30 per month in the US without insurance or even as little as $5 per month with select prescription programs.5 Although widely accessible and well tolerated by most, fewer than 50% of patients with a gout diagnosis are started on urate-lowering medications.6 Perhaps even more disheartening is the dismal number of patients who adhere to ULT once initiated. A retrospective cohort study of over 13,000 patients with gout recently initiated on allopurinol demonstrated that 57% of patients took their medication less than 80% of the time over the course of a year, and 68% of subjects did not reach a goal serum urate (SU) of < 6 mg/dL.7 A metaanalysis pooling data from 22 studies found that adherence (defined by a variety of methods including prescription claims, pill counts, self-report, and interview) was 47%. … Address correspondence to Dr. L.N. Helget, Assistant Professor of Medicine, Department of Internal Medicine, Division of Rheumatology and Immunology, 986270 Nebraska Medical Center, Omaha, NE 68198-6270, USA. Email: lindsay.helget{at}unmc.edu.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".