Background/Purpose: Gout is a frequent co-morbidity of solid organ transplant (SOT). Cyclosporine (CsA) is often cited as the main cause of gout in SOT, as other immunosuppressant (IS) regimens were associated with lower gout rates (e.g. 1980s studies of azathioprine monotherapy). In most guidelines & institutions, tacrolimus (TAC) has replaced CsA in SOT IS regimens. However, two questions are largely unknown: (1) to what degree is CsA still used among prevalent SOT patients? (2) can CsA fully explain high rates of gout still seen among SOT patients? This retrospective patient claims data analysis was performed to evaluate IS use and gout in the prevalent SOT population.

Methods: IS regimens and gout prevalence among prevalent SOT patients were assessed via commercial claims data (IQVIA^TM Real-World Data Adjudicated Claims – US). Definitions used were – SOT: claim with an SOT procedure code OR any claim with a history of SOT status code; IS: ≥1 claim for a given IS drug in the calendar year; Gout: ≥1 claim with any gout diagnosis code. IS use at time of transplant for 2016 recipients was obtained from the Organ Procurement and Transplantation Network (OPTN).

Results: The proportion of prevalent SOT patients on CsA declined from 2012 to 2016: heart 22% to 18%, kidney 21% to 17%, lung 16% to 11%, liver 15% to 12% (all p<0.01). TAC use increased: heart 66% to 73%, kidney 67% to 74%, lung 75% to 80%, liver 77% to 82% (all p<0.01). CsA use was higher in prevalent vs. incident SOT populations (e.g. 17% vs. 1.7% kidney 2016, p<0.0001). 2016 gout prevalence was 16% vs. 8% among CsA vs. non-CsA patients. Among all SOT patients with gout, 69% and 26% were on TAC and CsA, respectively.

Conclusion: Despite declining CsA use, gout remains a problem in SOT patients. For one, this study finds that many prevalent SOT patients still receive CsA. Additionally, gout prevalence in the non-CsA population was much higher (8%) than established rates reported in the general population (e.g. 3.9%). This suggests CsA is not the sole driver of gout in SOT. In fact, this analysis finds that post SOT, more than twice as many gout sufferers are on TAC than on CsA. Physicians should be aware that with any transplant IS regimen including calcineurin inhibitors, gout is likely to remain a frequent co-morbidity of SOT.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/immunosuppressant-use-and-gout-in-the-prevalent-solid-organ-transplant-population/