Maes Marina L, Saseen Joseph J, Wright Garth, Claus Liza W
Pharmacy Practice Division, University of Wisconsin - Madison School of Pharmacy, Madison, WI, USA.
Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
Clin Rheumatol. 2021 Mar;40(3):1017-1026. doi: 10.1007/s10067-020-05265-3. Epub 2020 Aug 15.
Determine the real-world incidence of acute gout prophylaxis (AGP) prescribing when a xanthine oxidase inhibitor (XOI) is initiated and describe characteristics of AGP prescribing.
Retrospective cohort analysis from 2007 to 2017 using medical and prescription claims from an administrative database (IQVIA™ Health Plan Claims Database) among adult patients with a diagnosis of gout. Primary endpoint was the proportion of patients receiving AGP among all patients newly initiated on XOI therapy. Secondary endpoints included incidence proportions of acute flare and of XOI discontinuation among patients who received AGP compared to those who did not. Chi-square and Fisher's exact tests were used in univariate analysis of proportions between treatment groups.
A total of 7414 patients were included for analysis. There were 697 patients (9.4%) who received AGP with XOI initiation and colchicine alone was the most common medication used among patients who received prophylaxis (n = 303, 43.4%). The incidence proportion of patients with an acute gout flare within 3 months of index was 21.5% in the AGP cohort and 12.7% in the no prophylaxis cohort (p < 0.001). The proportion of patients who discontinued XOI within 12 months of initiation was 38.7% in the AGP cohort and 46.2% in the no prophylaxis cohort (p < 0.001).
In the real world, the proportion of patients who receive AGP with initiation of XOI therapy is low and discontinuation of XOI within 12 months of initiation is significant. In this analysis, use of AGP was not associated with a lower risk of acute gout flare after initiation of XOI therapy. Key Points • Real-world acute gout prophylaxis (AGP) prescribing with xanthine oxidase inhibitor (XOI) initiation is very low despite current guideline recommendations • More than one third of patients discontinue XOIs within 12 months of initiation regardless of AGP prescribing.
确定开始使用黄嘌呤氧化酶抑制剂（XOI）时急性痛风预防（AGP）处方的真实世界发生率，并描述AGP处方的特征。
使用行政数据库（IQVIA™健康计划索赔数据库）中的医疗和处方索赔数据，对2007年至2017年诊断为痛风的成年患者进行回顾性队列分析。主要终点是所有新开始接受XOI治疗的患者中接受AGP的患者比例。次要终点包括接受AGP的患者与未接受AGP的患者相比急性发作和XOI停药的发生率。卡方检验和Fisher精确检验用于治疗组间比例的单变量分析。
共有7414例患者纳入分析。697例患者（9.4%）在开始使用XOI时接受了AGP，在接受预防的患者中，单独使用秋水仙碱是最常用的药物（n = 303，43.4%）。在索引后3个月内发生急性痛风发作的患者发生率在AGP队列中为21.5%，在无预防队列中为12.7%（p < 0.001）。在开始后12个月内停用XOI的患者比例在AGP队列中为38.7%，在无预防队列中为46.2%（p < 0.001）。
在现实世界中，开始XOI治疗时接受AGP的患者比例较低，且在开始后12个月内停用XOI的情况较为显著。在本分析中，使用AGP与开始XOI治疗后急性痛风发作风险较低无关。要点 • 尽管有当前指南推荐，但在开始使用黄嘌呤氧化酶抑制剂（XOI）时进行现实世界急性痛风预防（AGP）处方的情况非常少见 • 无论是否进行AGP处方，超过三分之一的患者在开始后12个月内停用XOI。
