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Abstract Number: 1186

Use Of High-Dose Allopurinol To Reach Serum Uric Acid Targets In Patients With Gout Across Multiple Countries

Jasvinder A. Singh1, Chris Storgard2, Scott Baumgartner3 and Robert Morlock4, 1Department of Medicine, University of Alabama, Tuscaloosa, AL, 24939 Directors Place, Ardea Bioscience, San Diego, CA, 3Ardea Biosciences, San Diego, CA, 4Ardea Bioscience, San Diego, CA

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: gout, rheumatologic practice, treatment and uric acid

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Session Information

Title: Metabolic and Crystal Arthropathies I

Session Type: Abstract Submissions (ACR)

Background/Purpose: Allopurinol is the most commonly used urate-lowering therapy (ULT) in the world. Although allopurinol is FDA approved for up to 800 mg/d and EMEA authorized for up to 900 mg/d, the majority of patients with gout receive ≤300 mg/d. We describe physician, patient, and treatment characteristics in patients with gout treated with allopurinol.

Methods: Data from a quantitative survey of physicians in the United States (US), France, Germany, Italy, Spain, and the United Kingdom (UK) were assessed and results confirmed through in-depth chart audits. Initial and current allopurinol doses, presence of comorbid conditions, use of anti-inflammatory prophylaxis for flare prevention, serum uric acid (sUA), physician subspecialty, and patient factors were evaluated. Data on number of patients achieving target sUA <6 mg/dL were also collected. Results are presented as proportions or means and standard deviations (SD). Descriptive statistics and multivariable-adjusted logistic regression analyses were used to describe patients with sUA <6 mg/dL.

Results: In total, 251 rheumatologists and 250 primary care physicians were interviewed. Of 2505 patients, 1437 (57%) were treated with allopurinol.

Table 1 presents patient characteristics, treatment, and percent with sUA <6 mg/dL.

Table 1. Patients Treated with Allopurinol: Unadjusted Characteristics by Country

 

France

(n=146)

Germany

(n=180)

Italy

(n=167)

Spain

(n=186)

UK

(n=137)

US

(n=621)

Age, years (mean±SD)

63±9.7

60±11.5

62±11.2

58±10.7

56±13.4

57±12.2

Male (n, %)

112 (77)

148 (82)

139 (83)

167 (90)

118 (86)

515 (83)

Comorbidities (n, %)
-Hypertension
-Cardiovascular disease
-Kidney disease
-Diabetes

53 (36)
26 (18)
12 (08)
25 (17)

 106 (59)
 45 (25)
 23 (13)

 40 (22)

75 (45)
42 (25)
23 (14)
42 (25)

 91 (49)
24 (13)

13 (7)
 24 (13)

52 (38)
30 (22)
34 (25)
19 (14)

348 (56)

112 (18)

  81 (13)

143 (23)

Allopurinol dosing (n, %)
      <300 mg/d

300 mg/d

>300 to <600 mg/d

≥600 mg/d

74 (51)

64 (44)

5 (3.4)

3 (2.1)

54 (30)

117 (65)

5 (2.8)

4 (2.2)

47 (28)

104 (62)

9 (5.4)

8 (4.8)

67 (36)

108 (58)

5 (2.7)

7 (3.8)

29 (21)

62 (45)

27 (20)

19 (14)

139 (22)

361 (58)

86 (14)

 35 (5.6)

Average allopurinol dose (mean±SD)          

239±97.2

261±96.9

279±119.0

249±116.8

347±168.5 

303±129.3 

Months on allopurinol (mean±SD)

48±56.8

35±42.4

39±46.3

59±67.9

42±53.2

43±53.7

% sUA ≤6 mg/dL (n, %)

57 (39)

61 (34)

 62 (37)

48 (26)

92 (67)

261 (42)

Across all countries, the majority of patients were treated with ≤300 mg/d of allopurinol; ≤6.5% in France, Germany, and Spain were given >300 mg/d, whereas 10% in Italy, 19.6% in the US, and 34% in the UK achieved a dose >300 mg/d (p<0.01).  Over 12 months, the number of patients achieving target sUA <6.0 mg/dL differed across the 6 countries (Spain < Germany < Italy ≥600 mg/d of allopurinol. However, only physician subspecialty [general practitioners vs rheumatologists (OR 0.56; p<0.01)], UK vs other countries (OR 3.51; p<0.01), time on therapy (OR 1.39; p=0.04), and chart-documented coexisting alcoholism (OR 0.67; p<0.05), hyperlipidemia (OR 0.74; p<0.05), hypertension (OR 1.4; p<0.05), and kidney stones (OR 0.49; p<0.05) were found to be associated with achieving sUA <6 mg/dL. After adjusting for confounding factors (age, sex, time on ULT, dose, comorbid conditions, physician type), allopurinol dose was not associated with achieving sUA <6 mg/dL.

Conclusion: Allopurinol is the most widely used ULT. Although it is approved for up to 800 mg/d in the US and 900 mg/d in the EU, the majority of patients are treated with ≤300 mg/d. On average, <50% of patients achieve sUA <6 mg/dL at any allopurinol dose.


Disclosure:

J. A. Singh,

Takeda and Savient,

2,

Savient, Takeda, Ardea, Regeneron, Allergan, URL pharmaceuticals, and Novartis,

5;

C. Storgard,

AstraZeneca,

1,

Ardea Biosciences, a wholly owned subsidiary of AstraZeneca,

3;

S. Baumgartner,

Stock options AstraZeneca,

1,

Full time employment Ardea Biosciences, a wholly owned subsidiary of AstraZeneca,

3;

R. Morlock,

Employee of Ardea Biosciences, Inc,

3.

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