Comparison of persistence rates between allopurinol and febuxostat as first-line urate-lowering therapy in patients with gout: an 8-year retrospective cohort study

Kim, Aran; Kim, Yun-Kyung; Kim, Geun-Tae; Ahn, Eun-Young Erin; So, Min Wook; Lee, Seung-Geun

doi:10.1007/s10067-020-05161-w

Cited by 21 publications

(22 citation statements)

References 41 publications

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“…In general, persistence with taking allopurinol was short, with a median 5 months for the 300‐mg tablet size. This is consistent with previous studies indicating that persistence with allopurinol ranged from 4 to 12 months, 15 but is much shorter than the 42 months from a Korean study 21 . Our study also found that 64% of patients discontinued the 300‐mg tablet size within a year, with 72% discontinuing by 2 years.…”

Section: Discussionsupporting

confidence: 92%

“…This is consistent with previous studies indicating that persistence with allopurinol ranged from 4 to 12 months, 15 but is much shorter than the 42 months from a Korean study. 21 Our study also found that 64% of patients discontinued the 300-mg tablet size within a year, with 72% discontinuing by 2 years. A recent study conducted in Canada examining persistence with ULT over 3 years observed that 41% of patients discontinued therapy by the third year.…”

Section: Discussionsupporting

confidence: 67%

“…Data based on medical records have revealed that the most common reasons for ULT discontinuation were poor health literacy, followed by perceived lack of effectiveness and adverse events. 21 Poor health literacy F I G U R E 3 The persistence to allopurinol 100 mg over 24 months since initiating therapy stratified based on (A) presence of concomitant colchicine and (B) age at initiation is increasingly recognised as a public health problem worldwide, 22 and approximately half of patients with gout were reported to have insufficient health literacy. 23 Poor health literacy is likely to lead to poor ULT persistence.…”

Section: Discussionmentioning

confidence: 99%

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Persistence with urate‐lowering therapy in Australia: A longitudinal analysis of allopurinol prescriptions

Coleshill

Day

Tam

et al. 2022

Brit J Clinical Pharma

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Aim: Gout is the most common form of inflammatory arthritis in men. Despite the availability of effective urate-lowering therapies (ULT), the management of gout is suboptimal due to poor persistence with ULT. This study examined national prescribing patterns of ULT to determine persistence with allopurinol in Australia.Methods: A 10% sample of the Australian Pharmaceutical Benefits Scheme dispensing claims database was used to identify individuals initiated on allopurinol between April 2014 and December 2019. The number of allopurinol scripts dispensed was used to estimate persistence with allopurinol. Persistence was defined as the number of months from initiation until discontinuation (last prescription with no further scripts acquired for a period thereafter). Kaplan-Meier curves were used to examine persistence, while Cox regression analysis was used to examine the influence of gender, concomitant colchicine and age.Results: The largest drop in persistence occurred immediately after initiation, with 34% of patients discontinuing allopurinol 300-mg therapy in the first month. Median persistence with allopurinol 300 mg was 5 months (95% confidence interval 4.76-5.24), with around 63% of individuals not persisting with this therapy for more than 12 months. Concomitant prescription of colchicine on the day of allopurinol initiation only occurred in 7% of allopurinol initiations. No increase in persistence was observed for those co-prescribed colchicine. Conclusion:Persistence with allopurinol was poor. More effective methods targeting prescribers, patients and systems are required to promote persistence with allopurinol. Improving persistence to allopurinol is an important public health goal given the proven potential of this medication to eliminate gout.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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Persistence with urate‐lowering therapy in Australia: A longitudinal analysis of allopurinol prescriptions

Coleshill

Day

Tam

et al. 2022

Brit J Clinical Pharma

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“…Lack of efficacy indicates failure to respond to anti-TNF-α agents or worsening of disease activity. Poor health literacy referred to the discontinuation of TNF-α inhibitors, owing to unawareness of the significance of regular use of these medications in the management of AS [ 46 ].…”

Section: Methodsmentioning

confidence: 99%

High Baseline Neutrophil-to-Lymphocyte Ratio Could Serve as a Biomarker for Tumor Necrosis Factor-Alpha Blockers and Their Discontinuation in Patients with Ankylosing Spondylitis

et al. 2023

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Background: This study explores the association of neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), and platelet-to-lymphocyte (PLR) ratios with the 3-month treatment response and persistence of tumor necrosis factor-alpha (TNF-α) blockers in patients with ankylosing spondylitis (AS). Methods: This retrospective cohort study investigated 279 AS patients who were newly initiated on TNF-α blockers between April 2004 and October 2019 and 171 sex- and age-matched healthy controls. Response to TNF-α blockers was defined as a reduction in the Bath AS Disease Activity Index of ≥50% or 20 mm, and persistence referred to the time interval from the initiation to discontinuation of TNF-α blockers. Results: Patients with AS had significantly increased NLR, MLR, and PLR ratios as compared to controls. The frequency of non-response at 3 months was 3.7%, and TNF-α blockers’ discontinuation occurred in 113 (40.5%) patients during the follow-up period. A high baseline NLR but not high baseline MLR and PLR showed an independently significant association with a higher risk of non-response at 3 months (OR = 12.3, p = 0.025) and non-persistence with TNF-α blockers (HR = 1.66, p = 0.01). Conclusions: NLR may be a potential marker for predicting the clinical response and persistence of TNF-α blockers in AS patients.

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“…However, Koreans have a much higher risk of AHS than Westerners; therefore, the Korean FDA continues to maintain febuxostat as a first-line ULT along with allopurinol, and it is the most commonly used ULT in Korea [ 72 ]. Moreover, febuxostat showed a significantly higher persistence rate than allopurinol among Korean patients with gout after adjusting for confounding factors [ 73 ]. Dose adjustment of febuxostat is not necessary for patients with mild or moderate renal impairment, since its main route of elimination is the liver [ 70 ].…”

Section: Pharmacologic Treatment For Goutmentioning

confidence: 99%

Current state and prospects of gout treatment in Korea

Park

Choi

Song

2022

Korean J Intern Med

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Effective management of gout includes the following: appropriate control of gout flares; lifestyle modifications; management of comorbidities; and long-term urate-lowering therapy (ULT) to prevent subsequent gout flares, structural joint damage, and shortening of life expectancy. In addition to traditional treatments for gout, novel therapies have been introduced in recent years. Indeed, new recommendations for the management of gout have been proposed by various international societies. Although effective and safe medications to treat gout have been available, management of the disease has continued to be suboptimal, with poor patient adherence to ULT and failure to reach serum urate target. This review outlines recent progress in gout management, mainly based on the latest published guidelines, and specifically provides an update on efficient strategies for implementing treatment, efficacy and safety of specific medications for gout, and cardiovascular outcomes of ULT. In particular, we reviewed gout management approaches that can be applied to a Korean population.

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Comparison of persistence rates between allopurinol and febuxostat as first-line urate-lowering therapy in patients with gout: an 8-year retrospective cohort study

Cited by 21 publications

References 41 publications

Persistence with urate‐lowering therapy in Australia: A longitudinal analysis of allopurinol prescriptions

Persistence with urate‐lowering therapy in Australia: A longitudinal analysis of allopurinol prescriptions

High Baseline Neutrophil-to-Lymphocyte Ratio Could Serve as a Biomarker for Tumor Necrosis Factor-Alpha Blockers and Their Discontinuation in Patients with Ankylosing Spondylitis

Current state and prospects of gout treatment in Korea

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