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Abstract Number: 2058

A Study on Febuxostat Prescribing Practices for Patients with Chronic Gout Previously Managed with Allopurinol at the Veterans Affairs Puget Sound

Percy Balderia and Elizabeth R. Wahl, Rheumatology, University of Washington School of Medicine, Seattle, WA

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Allopurinol, Febuxostat, Gout and uric acid

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Session Information

Date: Tuesday, November 7, 2017

Session Title: Metabolic and Crystal Arthropathies Poster II

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: American College of Rheumatology (ACR) guidelines recommend use of either allopurinol or febuxostat as first-line approaches to urate lowering therapy in gout. Prior studies of managed care cohorts have shown that patients are commonly switched to febuxostat before their allopurinol dose has been optimized. While each is effective, their cost differential (8 cents/pill compared to 5 dollars/pill at our facility) suggests there may be good reason to favor allopurinol use within a health system. To identify potential areas for improvement for allopurinol and febuxostat use, we sought to better understand current febuxostat prescribing practices at our facility among patients with chronic gout who were initially on allopurinol.

Methods: Data were extracted from the local pharmacy prescription database to identify all patients ≥ 18 years of age, seen at our facility, and prescribed febuxostat between 1/1/13 and 8/31/16. We conducted a retrospective chart review to identify the daily dose of allopurinol before febuxostat prescription. Additionally, the type of prescribing physician (rheumatologist, non-rheumatologist), reason for prescribing febuxostat (inadequate response to other medications, kidney dysfunction, allopurinol hypersensitivity), uric acid level, estimated glomerular filtration rate (GFR) at time of switch, presence of tophi, and demographic data were recorded.

Results: Sixty-four patients with chronic gout were switched from allopurinol to febuxostat. Forty-two patients were switched due to adverse drug events (most commonly rash, n = 17 or gastrointestinal symptoms, n = 8) and 22 due to inadequate response.

 

Table 1. Characteristics of Patients Switched to Febuxostat Due to Inadequate Response to Allopurinol

Characteristic

Result

n = 22

Age in y: median (IQR)

63 (9.3)

Male: n (%)

21 (95.5)

Tophaceous gout: n (%)

6 (27.3)

Allopurinol duration in months: median (IQR)

49 (41.5)

Documented trial of probenecid: n (%)

3 (13.6)

Uric acid level in mg/dL: median (IQR)

9.2 (3.3)

Table 2. Allopurinol Dosing Prior to Switching to Febuxostat According to Estimated Glomerular Filtration Rate

Estimated GFR in mg/dL/m2: range (n)

Daily Dose in mg: median (IQR), range

≤30 (10)

300 (175), 100-450

>30 – ≤60 (8)

300 (100), 50-825

>60 (4)

600 (100), 600-800

Conclusion: In our facility, most of the patients were prescribed febuxostat due to adverse effects from allopurinol. Among those switched due to inadequate response, almost two-thirds had a dose of 300 mg/day or less.

 


Disclosure: P. Balderia, None; E. R. Wahl, None.

To cite this abstract in AMA style:

Balderia P, Wahl ER. A Study on Febuxostat Prescribing Practices for Patients with Chronic Gout Previously Managed with Allopurinol at the Veterans Affairs Puget Sound [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/a-study-on-febuxostat-prescribing-practices-for-patients-with-chronic-gout-previously-managed-with-allopurinol-at-the-veterans-affairs-puget-sound/. Accessed July 4, 2022.
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