Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
In the US, 3.9% (8.3 million) of the population have self-reported gout, and 21.4% (43.3 million) have hyperuricemia. The 2012 ACR guidelines recommend febuxostat or allopurinol as first line urate-lowering therapy (ULT). In this study, outcomes in ULT-naïve patients in community clinics were investigated based on prescriptions patterns for allopurinol or febuxostat.
Methods:
Centricity Electronic Medical Record database of ambulatory care by General Electric was used. Patients (≥18 years of age), newly diagnosed with gout (ICD-9, 274.xx) on or after 2005 and initiated on allopurinol or febuxostat were included. Study index date was defined as date of first initiated ULT in patients with at least 6 months of data pre- and post study index. Study groups consisted of patients first prescribed either ULT. Patients were followed to date of last record. Primary study endpoint was reaching target serum urate (sUA) of <6mg/dL in 6 months from index. Descriptive statistics and bivariate analyses were performed. Logistic regressions compared the likelihood to reach target sUA after either ULT accounting for several relevant covariates such as age, gender, baseline sUA and Charlson co-morbidity index (CCI).
Results:
17,199 (93.5%) patients started on allopurinol and 1190 (6.5%) patients started on febuxostat were enrolled. Overall study cohort had a mean age of 63.7±13.3 (standard deviation, SD), with 69.4% male, and 79.7% white. Mean follow-up duration from index to last record was 541.5±237.9 days. No significant differences between 2 ULT-treated groups were found for age, CCI, gender, race, or in having hypertension. Febuxostat group was more likely to have lower estimated glomerular filtration rate (eGFR; 46.4% vs 34.7% with <60 ml/min), higher overall mean baseline sUA (68.8% vs 68.0% with >=8 mg/dL), and twice as many with tophi (1.68% vs 0.88%), all p<0.05. Among the overall study cohort, 10,871 patients (59.1%) had sUA level after initiating ULT. 59.12% of the patients had documented sUA levels after initiation of ULT. Patients who had sUA measurement post study index date included 10,119 (93.1%) in the allopurinol and 752 (6.9%) in the febuxostat groups. Proportions reaching target were 29.2% in the allopurinol group and 42.2% in the febuxostat group (p<0.05) at 6-month follow-up. At 2 years post initiating ULT, 58.2 % of the patients in the febuxostat and 48.4% in the allopurinol treated groups reached target sUA levels (p<0.05).
Conclusion:
Among ULT naïve patients, those starting with febuxostat had higher baseline sUA, higher tophi and worse eGFR than those starting with allopurinol. In spite of their more advanced or severe gout, febuxostat treated patients were significantly more likely to achieve target sUA at 6 months. Since more than 40% of the patients did not have documented sUA levels after initiation of ULT and doses were not factored into the analysis, the generalizability of the study results is hindered. Also study duration may have impacted the reported findings.
Disclosure:
P. Khanna,
Puja Khanna,
5,
Puja Khanna,
8;
H. Hatoum,
Hind Hatoum,
5;
S. J. Lin,
Swu-Jane Lin,
5;
A. Shiozawa,
Takeda Pharmaceuticals International,
3;
K. Akhras,
Kasem Akhras,
3;
D. Khanna,
AstraZeneca Takeda Pharmaceuticals International, Savient,
5,
National Institutes of Health, Savient ,
2.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/outcome-of-allopurinol-or-febuxostat-treatment-in-gout-patients-naive-to-urate-lowering-therapy/