ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2240

Effectiveness of Allopurinol in Achieving and Sustaining Target Serum Urate: A Study Using Large Intergrated National Health Network

Jasvinder A. Singh1, Shuo Yang2, S. Louis Bridges Jr.3 and Kenneth G. Saag4, 1Birmingham VAMC, Birmingham, AL, 2Clinical Immunology/Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 3Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 4University of Alabama at Birmingham, Birmingham, AL

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords:

Session Information

Date: Tuesday, November 10, 2015

Title: Epidemiology and Public Health Poster III (ACR): Gout and Non-Inflammatory Musculoskeletal Conditions

Session Type: ACR Poster Session C

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

Background/Purpose:

To comprehensively assess patient, comorbidity, physician, system, health care access and disease factors associated with the ability to achieve and maintain target serum urate (sUA) with allopurinol in patients with gout.

Methods:

We used National VA national databases from 2002-2012.  Patients were eligible if they had ≥2 outpatient or ≥1 inpatient encounters with an International Classification of Diseases-ninth version (ICD-9) code 274.xx for gout, and met 12-month observability rule.  Index allopurinol use was defined as the filling of a new allopurinol prescription with no allopurinol exposure in the previous 121 days.  Treatment successes were defined as the achievement of: (1) post-index sUA <6 mg/dl; and (2) post-index sUA <6 mg/dl that was sustained, as defined by achievement of: (1) post-index sUA <6 mg/dl and at least one more follow-up sUA that was <6 mg/dl.

Results:

41,153 unique patients with 47,072 episodes contributed to analyses of achieving target sUA ≤ (success 1) and 17,402 unique patients with 18,323 episodes to achieving and maintaining target sUA  (success 2).  In multivariable-adjusted models, the following were associated with significantly higher odds of achieving both successes 1 and 2: older age, normal BMI (18.5-25 kg/m2), female sex, black/african-american race, peptic ulcer disease, severe liver disease, hypertension, rheumatologist as the main provider rather than non-rheumatologist, Midwest location for the health care facility, a lower hospital bed size, service-connection conditions of 50% or more, longer distance to the nearest VA facility, lower pre-index sUA, higher allopurinol start and end dose, higher allopurinol adherence, previous use of allopurinol with in 1 year and normal/recommended or fast allopurinol dose escalation. Diabetes with complications and paraplegia,  were associated with increased odds of not achieving success 1 and 2. Additionally, increasing BMI and greater baseline sUA showed a  clear linear trend toward not achieving success 1 and success 2. 

Conclusion:

In this study, we identified several important factors associated with achieving and maintaining sUA <6 mg/dl.  This knowledge provides several new potential modifiable targets for improving the ability to lower serum urate with allopurinol pharmacotherapy and sustain a therapeutic target in patients with gout. 

Table 1. Multivariable-adjusted association of factors with the ability to achieve and maintain target sUA of < 6mg/dl*

 

Success 1: Achieving post-index sUA <6 mg/dl

Success 2: Achieving and maintaining post-index sUA <6 mg/dl

 

Odds Ratio  (95% CI)

Odds Ratio    (95% CI)

Baseline Age

1.01 (1.01,1.02)

1.02 (1.01,1.02)

Female Sex

1.77 (1.38,2.27)

1.49 (1.03,2.16)

BMI Group  (Ref=18.5 to <25)

 

 

<18.5

0.77 (0.64,0.93)

0.85 (0.63,1.16)

 25 to <30

0.84 (0.77,0.91)

0.85 (0.74,0.97)

 30 to <35

0.73 (0.67,0.80)

0.70 (0.62,0.80)

 35 to <40

0.63 (0.57,0.69)

0.63 (0.55,0.73)

 40 to <45

0.55 (0.50,0.62)

0.52 (0.44,0.61)

 ≥45

0.51 (0.46,0.57)

0.54 (0.46,0.64)

Race  (Ref=White)

 

 

Black/African-American

1.16 (1.09,1.23)

1.22 (1.11,1.34)

Hispanic

0.89 (0.80,1.00)

0.84 (0.71,1.00)

Other

0.83 (0.75,0.92)

0.73 (0.62,0.86)

Unknown

0.86 (0.76,0.98)

0.94 (0.76,1.16)

Baseline Charlson (Ref = 0)

 

 

Peptic ulcer disease

1.55 (1.29,1.87)

1.42 (1.10,1.84)

Diabetes

0.92 (0.88,0.98)

0.89 (0.82,0.97)

Diabetes with complications

1.20 (1.11,1.31)

1.06 (0.94,1.19)

Paraplegia

1.55 (1.05,2.30)

1.45 (0.85,2.47)

Renal disease

1.01 (0.93,1.10)

0.88 (0.79,0.99)

Malignancy

1.15 (1.07,1.24)

1.00 (0.90,1.11)

Severe liver disease

2.48 (1.54,3.98)

1.98 (1.02,3.83)

Hypertension

1.12 (1.05,1.20)

1.15 (1.03,1.28)

 

 

 

Provider Specialty  (Ref=Rheumatology)

 

 

Other

0.70 (0.63,0.77)

0.73 (0.64,0.84)

Start Dose Group  (Ref=≤100 mg/day)

 

 

 >100 to ≤200

1.16 (1.06,1.27)

1.17 (1.04,1.31)

 >200 to ≤300

1.15 (1.03,1.30)

1.11 (0.96,1.28)

  >300

1.04 (0.84,1.30)

1.03 (0.76,1.41)

End Dose Group  (Ref=≤100 mg/day)

 

 

 >100 to ≤200

2.00 (1.82,2.19)

2.03 (1.79,2.29)

 >200 to ≤300

4.16 (3.70,4.67)

4.53 (3.93,5.22)

 >300

4.09 (3.38,4.95)

4.59 (3.64,5.77)

MPR Group  (Ref, >0.8)

 

 

<=0.4

–

–

>0.4 to ≤0.6

0.04 (0.03,0.05)

0.08 (0.06,0.13)

>0.6 to ≤0.8

0.06 (0.06,0.07)

0.11 (0.10,0.13)

Previous Usage in 1 Year Baseline  (Ref=0)

0.59 (0.56,0.63)

0.60 (0.55,0.66)

Dose Escalation  (Ref=No)

 

 

Fast

3.27 (2.27,4.70)

2.73 (1.43,5.22)

Normal

1.87 (1.53,2.30)

2.58 (1.91,3.48)

Slow

0.48 (0.44,0.53)

0.60 (0.54,0.68)

Gout Duration

0.98 (0.97,1.00)

1.00 (0.98,1.01)

Baseline sUA Value Group  (Ref=6 to <8)

 

 

0 to <6

2.71 (2.50,2.95)

2.50 (2.18,2.86)

8 to <10

0.65 (0.61,0.69)

0.65 (0.59,0.71)

10 to <12

0.46 (0.42,0.49)

0.44 (0.39,0.49)

≥12

0.37 (0.33,0.42)

0.40 (0.34,0.48)

* The following  variables were significantlying associated with increased odds of achieving success 1 and success 2.  (Ref= Mid-West): Mid-Atlantic,,North East,South,West; Operating Bed  (Ref= >200): ≤50, >50 to ≤100, >100 to ≤200; Urban Rural  (Ref=Urban); Affiliated to University  (Ref=No); OPC Type  (Ref=VAMC): CBOC, Other, VAMC & CBOC; MEANS  (Ref=AN): AS,C, G/N/U/X; Service Connection  (Ref=0%): >0 to <50%, ≥50%,None;Distance from Closest VA Facility within Network

 

Disclosure: J. A. Singh, None; S. Yang, None; S. L. Bridges Jr., None; K. G. Saag, Amgen, 2,Eli Lilly and Company, 2,Merck Pharmaceuticals, 2,Amgen, 5,Eli Lilly and Company, 5,Merck Pharmaceuticals, 5.

To cite this abstract in AMA style:

Singh JA, Yang S, Bridges SL Jr., Saag KG. Effectiveness of Allopurinol in Achieving and Sustaining Target Serum Urate: A Study Using Large Intergrated National Health Network [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/effectiveness-of-allopurinol-in-achieving-and-sustaining-target-serum-urate-a-study-using-large-intergrated-national-health-network/. Accessed .

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/effectiveness-of-allopurinol-in-achieving-and-sustaining-target-serum-urate-a-study-using-large-intergrated-national-health-network/