Dwid Naji A, Cheikh Mohamed M, Mandurah Ahmed S, Shikh-Souk Khaldoun A, Al-Khatib Khaled R, Ahmed Ans R
Doctor Soliman Fakeeh Hospital, Jeddah, KSA.
J Taibah Univ Med Sci. 2020 Apr 27;15(3):185-189. doi: 10.1016/j.jtumed.2020.03.009. eCollection 2020 Jun.
Physicians frequently prescribe allopurinol for uric acid deposition disorders. However, reports have emerged of the inappropriate use and overprescription of allopurinol. We conducted this study to determine the rate of inappropriate prescription of allopurinol in a Saudi institution.
This cross-sectional descriptive study was conducted on all adult patients who had been prescribed allopurinol in Doctor Soliman Fakeeh Hospital Jeddah KSA. Demographic data and laboratory results were retrieved from patients' electronic health records (EHR). We considered valid indications of allopurinol as significant hyperuricemia (>13 mg/dL in men and >10 mg/dL in women), confirmed gout, hyperuricosuria of more than 1100 mg/day, uric acid stones or recurrent calcium oxalate kidney stones, malignancy, and haemolysis. The possible valid indications were unconfirmed gout and unconfirmed type of kidney stones, whereas no documented indication or insignificant hyperuricemia was considered as an invalid indication.
We included 1978 patients in this study. The cohort was composed of 76.4% men and 23.6% women. The mean ± standard deviation of age of this patient cohort was 53 and 4 months ± 15 years. The mean ± standard deviation of duration since the first prescription was 1.53 ± 2.2 years. Physicians prescribed allopurinol without a valid indication in 1539 patients (77.8%). More than a third of the patients (39%) did not have a documented indication and 38.8% were prescribed allopurinol for insignificant hyperuricemia.
This study revealed a markedly high number of allopurinol prescriptions without a clear indication in our centre. This approach may potentially expose patients to serious side effects of allopurinol without added benefits.
医生经常为尿酸沉积症患者开具别嘌醇。然而，有关别嘌醇使用不当和过度处方的报道不断出现。我们开展这项研究以确定沙特一家机构中别嘌醇不当处方的比例。
这项横断面描述性研究针对沙特阿拉伯吉达市索利曼·法基赫医生医院所有开具了别嘌醇的成年患者进行。人口统计学数据和实验室检查结果从患者的电子健康记录（EHR）中获取。我们将别嘌醇的有效适应证视为显著高尿酸血症（男性>13mg/dL，女性>10mg/dL）、确诊痛风、每日尿酸排泄量超过1100mg的高尿酸尿症、尿酸结石或复发性草酸钙肾结石、恶性肿瘤以及溶血。可能的有效适应证为未确诊的痛风和未明确类型的肾结石，而无记录的适应证或不显著的高尿酸血症则被视为无效适应证。
本研究纳入了1978例患者。该队列中男性占76.4%，女性占23.6%。该患者队列的平均年龄±标准差为53岁4个月±15岁。自首次处方以来的平均疗程±标准差为1.53±2.2年。1539例患者（77.8%）在没有有效适应证的情况下被医生开具了别嘌醇。超过三分之一的患者（39%）没有记录的适应证，38.8%的患者因不显著的高尿酸血症被开具了别嘌醇。
本研究显示，在我们中心，大量别嘌醇处方并无明确适应证。这种做法可能会使患者在没有额外益处的情况下面临别嘌醇的严重副作用。
