Critical revision of the medical treatment of gout in Brazil

Azevedo, Valderílio Feijó; Lopes, Maicon Piana; Catholino, Nathan Marostica; Paiva, Eduardo dos Santos; Araújo, Vitor Andrei; Pinheiro, Geraldo da Rocha Castelar

doi:10.1016/j.rbre.2017.03.002

“…Maximum patients (i.e., 266, 69.3%) aged 34 to 63 years were suffering from low risk of progression to CKD with gout, and the high risk increased in the age range 54-63 and ≥ 84 years by 17 and 43 times, respectively. The finding was in line with various published findings that gout mainly affects men over the age of 40 years [6,7,14,[25][26][27]. Such slight variation might be due to the inclusion of all age groups in the present research.…”

Section: Discussionsupporting

confidence: 93%

“…Gouty arthritis and tophi may lead to chronic disability, impair health-related quality of life (HRQoL), increase healthcare resources and reduce productivity [2][3][4]. Gout has prevalence of 1.14%, 1.7%, 2.49%, 2.7% and 4% in China, Australia, UK, New Zealand, and US respectively [1,3,5,6] and its prevalence is rising every year both in developing and developed countries due to various factors such as high BMI (as obesity increases endogenous uric acid production), and concomitant diseases (e.g., hypertension), consumption of purine-rich diets (e.g., red meat, high-fructose syrup or beverage, beer, seafood), and medications (e.g., diuretics, cyclosporine) [4,6,[7][8][9][10]. Countrywide gout prevalence is understudied domain in Nepal like other developing countries [11], and one research found a district-wise prevalence of 21.42% at Chitwan district, one of the districts out of 13 in Bagmati Province in Nepal [12].…”

Section: Introductionmentioning

confidence: 99%

Dosage individualization proposed for anti-gout medications among the patients with gout: a bicentric study in Nepal

Sapkota

¹

,

Chaudhary

²

,

Gurung

³

et al. 2020

Preprint

0

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BackgroundThe conventional one-size-fits-all approach has been criticized for almost all drugs used especially for chronic diseases, including gout. The present study was aimed to individualize and optimize the dose of anti-gout medications among gout patients.Methods and findingsBicentric cross-sectional study was carried out among 384 randomly selected new gout patients visiting two gout treatment centers at Lalitpur Metropolitan City, Nepal and taking antigout medications. Patients not taking anti-gout medications and not showing unwillingness to participate were excluded. The eGFR was calculated with the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation (2009). Doses to be individualized were decided based on the Renal Drug Handbook and BNF 80. Data were analyzed via R 4.0.3. Multinomial logistic regression analysis was performed to analyze statistical significance of risk with various predictors, considering a p-value <0.05 statistically significant. Comorbidities were coded as per the ICD-11 coding and ATC classification of medicines as per the WHO Guidelines for ATC classification and DDD assignment 2020. High risk of progression to CKD increased in the age range 54-63 and ≥84 years by 17.77 and 43.02 times, respectively. High risk of gout increased by 29.83 and 20.2 times for overweight and obese patients respectively. Aceclofenac 100 mg was prescribed for maximum patients (117, 30.5%). Need of dose individualization was realized altogether in case of 30 patients (8%), with maximum (7, 1.8%) in case of etoricoxib 90 mg (i.e., avoid if possible). There were 260 (67.7%) cases without associated comorbidities, followed by 37 (9.6%) patients with hyperthyroidism. Various glucocorticoids were prescribed for 141 (36.9%) patients, out of whom 14 (3.8%) required dose individualization. Altogether 61 (15.9%) patients were prescribed with xanthine oxidase inhibitors, out of whom 5 (1.3%) required dose individualization.ConclusionsThirty (8%) cases required dose individualization, which was although minimal but could have meaningful impact on clinical success of individual patient. Based on the recommendation on dose individualization, those patients could be optimized on their therapy on future follow ups. Also, future randomized controlled trials may be based on these to derive a more conclusive evidence base for gout management.Author summaryWhy was this study done?Dosage individualization helps optimize drug selection and dosing based on pathogenesis, mechanism of action of drugs, and their dose exposure-response relationships.Very limited researches have been undertaken in Nepal to individualize medications for chronic medication users including gout patients. The present study was probably the first of its kind in Nepal aiming to individualize the dose of anti-gout medications among gout patients.What did the researchers do and find?Bicentric cross-sectional study was carried out among 384 new gout patients visiting two gout treatment centers in Nepal and taking antigout medications.Doses to be individualized were decided based on standard references of the Renal Drug Handbook and the British National Formulary 80. Dose to be individualized was later discussed with the prescribing physicians.Need of dose individualization was realized altogether in case of 30 patients (8%), with maximum (7, 1.8%) in case of etoricoxib 90 mg (i.e., avoid if possible).What do these findings mean?The present simple effort of individualization of antigout medications might help the physicians optimize the therapeutic success for the patients, once they implement it and patients adhere to it.Since the study was limited to only two gout and rheumatic diseases treatment centers, it might not represent the whole gout patients in the nation but it might provide the evidence base for future large controlled clinical trials.

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“…The high risk of progression increased in the age range 54-63 and �84 years by 17 and 43 times, respectively. The finding was in line with the various published findings that gout mainly affects men over the age of 40 years [6,7,14,[25][26][27]. Such slight variation might be due to the inclusion of all age groups in the present research.…”

Section: Discussionsupporting

confidence: 93%

“…Gout has prevalence of 1.14%, 1.7%, 2.49%, 2.7% and 4% in China, Australia, UK, New Zealand, and the USA respectively [1,3,5,6]. Its prevalence is rising every year both in the developing and the developed countries due to various factors such as high body mass index (BMI) (as obesity increases endogenous uric acid production), and concomitant diseases (e.g., hypertension), consumption of purine-rich diets (e.g., red meat, high-fructose syrup or beverage, beer, seafood), and medications (e.g., diuretics, cyclosporine) [4,6,[7][8][9][10]. Country-wise gout prevalence is understudied domain in Nepal like other developing countries [11], and district-wise prevalence was found to be 21.42% at Chitwan district, one of 76 districts in Nepal [12].…”

Section: Introductionmentioning

confidence: 99%

Dosage individualization proposed for anti-gout medications among the patients with gout

Sapkota

¹

,

Chaudhary

²

,

Gurung

³

et al. 2021

PLoS ONE

0

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Background The conventional one-size-fits-all approach has been criticized for almost all drugs used especially for chronic diseases, including gout. The present study was aimed to explore the need of individualization and optimization of the dose of anti-gout medications among gout patients. Methods Cross-sectional study was carried out among 384 randomly selected new gout patients visiting two gout treatment centers at Lalitpur Metropolitan City, Nepal and who were taking antigout medications. Patients not taking anti-gout medications and not showing willingness to participate were excluded. The eGFR was calculated with the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation (2009). Doses to be individualized were decided based on the Renal Drug Handbook and verified with the BNF 80. Data were analyzed via R 4.0.3 by applying the multinomial logistic regression to analyze statistical significance of risk with various predictors, and considering a p-value <0.05 statistically significant. Comorbidities were coded as per the ICD-11 coding and medicines were coded according to the WHO Guidelines for ATC classification and DDD assignment 2020. Results The high risk of progression to CKD increased in the age range 54–63 and ≥84 years by 17.77 and 43.02 times, respectively. Also, high risk increased by 29.83 and 20.2 times for the overweight and the obese respectively. Aceclofenac 100mg was prescribed for maximum patients (30.5%). Need of dose individualization was realized in 30 patients, with maximum (7) in case of etoricoxib 90mg. Various glucocorticoids were prescribed for 36.9% patients, out of whom 3.8%required dose individualization and 15.9% patients with xanthine oxidase inhibitors, out of whom 1.3% required dose individualization. Conclusion Thirty cases required dose individualization, which was although minimal but could have meaningful impact on the clinical success of the individual patient. Based on the recommendation on dose individualization, those patients could be optimized on their therapy on future follow ups.

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“…Several isolated aromatic herbs from plants, medicinal plants, www.ajpp.in Figure 3. Pharmacotherapy for controlling hyperuricemia and how they react within normal physiological condition within the human body (Azevedo et al, 2017) vegetables, fruits, cereals, nuts, legumes, seeds, spices, green and black tea hold oxygen scavenging capacity to obliterate the oxidation and inflammation reaction formed through enzyme xanthine oxidase. To dam, the formation of uric acid XO is clogged by active constituents of plant metabolites and via hydrophobic bonds produced XO-active metabolites composite besides blocked the free active site that dosen't allow additional binding.…”

Section: Underexcretion Of Uric Acidmentioning

confidence: 99%

Promising actions of certain medicinal and dietary plants for the management of hyperuricemia as a natural remedy: A review

Das¹,

Modak²,

Sarkar³

et al. 2020

Asian J Pharm Pharmacol

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Hyperuricemia ensues due to the reabsorption and diminished evacuation of uric acid which is accountable for the advancement of gout and radically concomitant with the progress of numerous long-lasting ailments for instance malignant tumor, cardiovascular ailments, and kidney failure. Underlying factors such as excessive intake of purine containing supplements, obesity, age, sex, sugar, and alcohol intake may condense the formation of uric acid and exaggerate the injurious effects of uric acid. Novel inventive pharmaceutical and curative mediations are being used for the tackling of hyperuricemia but the problem arises when patients complain about adverse reactions with serious complications that may increase the rate of developing new diseases. Medicinal and dietary plants with bioactive phytochemicals like polyphenols, flavonoids are more feasible due to less toxicity, more economical for developing countries, formulation advantages for primary healthcare, better appropriateness with human physiological conditions. To facilitate the design of plant-based alternative therapy it is a prerequisite to connecting herbal medicine with novel prescription and additional precise explorations have to be ensured for the authentication of the effectiveness and safety of herbal formulations. The existing assessment outlines production, metabolism, and excretion of uric acid, hazard influences (overabundance and low excretion of uric acid), conventional pharmacotherapy for hyperuricemia and its related complications, the use of plants, its origin; parts to be used, mechanism of actions to preclude hyperuricemia are highlighted based on of previously issued literature.

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Critical revision of the medical treatment of gout in Brazil

Cited by 7 publications

References 96 publications

Dosage individualization proposed for anti-gout medications among the patients with gout: a bicentric study in Nepal

Dosage individualization proposed for anti-gout medications among the patients with gout: a bicentric study in Nepal

Dosage individualization proposed for anti-gout medications among the patients with gout

Promising actions of certain medicinal and dietary plants for the management of hyperuricemia as a natural remedy: A review

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