Comorbidity Characteristics of Patients Starting First-Line Acute Gout Agents – Colchicine, NSAID, and Corticosteroids

Background/Purpose: There is a remarkable, increasing disease burden of gout and its associated comorbidities in the US.  The 2012 ACR gout management guidelines endorsed the use of colchicine, NSAIDs, and corticosteroids as appropriate first-line options for the treatment of acute gout.  Cardiovascular-metabolic-renal comorbidities of gout should dictate the choice among these agents, but relevant data are scarce.  To address this issue, we examined and compared the prevalence of major cardiovascular-metabolic-renal comorbidities in gout patients who were newly prescribed these three agents.  
Methods: We used US insurance claims data (2009–2012) to conduct a population-based study.  Subjects aged ≥18 years who had at least 1 visit coded with the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 274.xx for gout were identified. Patients diagnosed with cancer (ICD-9-CM codes: 140.xx-208.xx, 230.xx-234.xx) any time before or after the index date were excluded. Acute gout attacks were identified by an outpatient visit coded for gout, followed by a new dispensing of colchicine, NSAIDs, or oral or injectable corticosteroids.  We assessed the comorbidity status during the 180 days prior to initiation of these acute gout care agents.

Results: There were 2,181 colchicine, 10,773 NSAID, and 2,364 corticosteroid initiators for acute gout attacks. The mean ages were 52, 49, and 51 years and 85, 85, 80% were men, respectively.  Compared with NSAID initiators, colchicine initiators had more comorbidities, including hypertension, hyperlipidemia, coronary heart disease, stroke, congestive heart failure, type 2 diabetes, and chronic kidney disease at the time of initiation (Table 1).  Compared with corticosteroid initiators, colchicine initiators had higher prevalences of hypertension, coronary heart disease, stroke, and type 2 diabetes, although the difference was less (Table 1). 

Conclusion: This large US insurance claims-based study indicates that patients who initiated colchicine for acute gout had more cardiovascular-metabolic comorbidities than those who initiated NSAIDs or corticosteroids. While some of these findings confirm expected prescription patterns, given the known adverse effects of these agents, the overall comorbidity profile of colchicine initiators was noteworthy.  These prescription patterns and pre-existing comorbidities should be appropriately taken into account for comparative effectiveness studies of these agents.  

NSAID: Non steroid anti-inflammatory drug.

^*Prevalence ratios were adjusted for age and gender.

^†Corticosteroids include prednisone and methylprednisolone.