Evaluation of allopurinol use in patients with gout

Zell, Steven C.; Carmichael, Jannet M.

doi:10.1093/ajhp/46.9.1813

Cited by 6 publications

(6 citation statements)

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“…1,12,21 Published studies revealed inappropriate indications for allopurinol in up to 86% of patients. 13,[22][23][24][25][26] In the EuroSCAR study the indications for allopurinol use were recorded in a nonsystematic manner and the patients' original charts were not reviewed. A comparison of allopurinol exposure between the previous SCAR study (1989)(1990)(1991)(1992)(1993) and the current EuroSCAR study (1997)(1998)(1999)(2000)(2001) showed a 2-to 3-fold increase in the exposure of control subjects and patients.…”

Section: Discussionmentioning

confidence: 99%

“…Adherence to accepted guidelines for the use of allopurinol 14 could lead to a significant decrease in morbidity and mortality from allopurinol-associated SJS or TEN. Based on the literature, which shows inappropriate allopurinol prescription in up to 86% of treated patients, 22,24 it may be assumed that up to 48 of 56 patients with SJS or TEN with recent intake of allopurinol in the EuroSCAR study could have been prevented. Based on the known incidence of SJS or TEN (2 cases/million population/y), the extrapolation of our results (14.8% of SJS or TEN cases induced by recent allopurinol use with a 32% death rate) to the whole European population (376 million) leads to an estimate that about 100 cases of SJS or TEN and as many as 30 deaths related to these reactions could be avoided each year in Europe by a more appropriate use of allopurinol.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Allopurinol is the most common cause of Stevens-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel

Halevy

Ghislain

Mockenhaupt

et al. 2008

Journal of the American Academy of Dermatology

421

312

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Allopurinol is the most common cause of Stevens-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel

Halevy

Ghislain

Mockenhaupt

et al. 2008

Journal of the American Academy of Dermatology

421

312

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“…In the present study, 26 of the 32 patients (81%) who underwent desensitization had renal insufficiency; 18 of them (69%) were taking concomitant diuretics, and 21 (80%) were receiving 300 mg of allopurinol daily—an inappropriate dosage for their degree of renal insufficiency. Recent reports indicate that allopurinol, at a “standard” dosage of 300 mg/day, is the most frequently prescribed urate‐lowering drug(34, 35) and that not all physicians adjust the initial dosage according to the degree of renal insufficiency(35). In this study, daily allopurinol dosages following desensitization were considerably lower than the predesensitization dosages, further emphasizing the importance of dosage reduction in patients with renal impairment(26).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of desensitization to allopurinol following cutaneous reactions

Fam

Dunne

Iazzetta

et al. 2001

Arthritis & Rheumatism

102

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Objective To evaluate the long‐term efficacy and safety of slow oral desensitization in the management of patients with hyperuricemia and allopurinol‐induced maculopapular eruptions. Methods A retrospective evaluation of an oral desensitization regimen using gradual dosage‐escalation of allopurinol in 32 patients (30 with gout and 2 with chronic lymphocytic leukemia) whose therapy was interrupted because of a pruritic cutaneous reaction to the drug. Results Twenty‐one men and 11 women with a mean age of 63 years (range 17–83 years), a mean serum urate level of 618 μmoles/liter (range 495–750) (or, mean 10.4 mg/dl [range 8.3–12.6]), and a mean serum creatinine level of 249 μmoles/liter (range 75–753) (or, mean 2.8 mg/dl [range 0.8–8.5]) were studied. Desensitization failed in 4 patients because of unmanageable recurrent rash. Twenty‐eight patients completed the desensitization procedure to a target allopurinol dosage of 50–100 mg/day, 21 without deviation from the protocol for a mean of 30.5 days (range 21–56 days) and 7 requiring dosage adjustments because of a recurrent rash over 53.8 days (range 40–189 days). Seven of these 28 patients developed late cutaneous reactions 1–20 months postdesensitization, 4 responding to dosage modification and 3 discontinuing the drug. Twenty‐five of the 32 patients (78%) continued to take allopurinol; their mean duration of followup was 32.6 months (range 3–92 months) and the mean postdesensitization serum urate level was 318 μmoles/liter (range 187–452) (or, mean 5.3 mg/dl [range 3.0–7.5]). Conclusion The study confirms the long‐term efficacy and safety of slow oral desensitization to allopurinol in patients with maculopapular eruptions, particularly in those with gout, who cannot be treated with uricosurics or other urate‐lowering drugs. Although pruritic skin eruptions may recur both during and after desensitization, most of these cutaneous reactions can be managed by temporary withdrawal of allopurinol and dosage adjustment.

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“…Gout is the most common inflammatory arthritis, affecting 7.5 million adults in the US and, commensurate with the obesity epidemic, is increasing in prevalence (). The deleterious effect of urate deposition on physical function and health‐related quality of life is associated with increased health care costs () but can be improved with appropriate pharmacologic and nonpharmacologic management, including urate‐lowering therapy (ULT) and dietary modification, respectively (). Comorbidities, however, limit the choice and dose of pharmacologic therapy, and nonpharmacologic modalities become essential options in gout management.…”

Section: Introductionmentioning

confidence: 99%

Measuring Physician Adherence With Gout Quality Indicators: A Role for Natural Language Processing

Kerr

Richards

Nunziato

et al. 2015

Arthritis Care & Research

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Objective. To evaluate physician adherence with gout quality indicators (QIs) for medication use and monitoring, and behavioral modification (BM). Methods. Gout patients were assessed for the QIs as follows: QI 1: initial allopurinol dosage <300 mg/day for patients with chronic kidney disease (CKD); QI 2: uric acid within 6 months of allopurinol start; and QI 3: complete blood count and creatinine phosphokinase within 6 months of colchicine initiation. Natural language processing (NLP) was used to analyze clinical narrative data from electronic medical records (EMRs) of overweight (body mass index >28 kg/m 2 ) gout patients for BM counseling on gout-specific dietary restrictions, weight loss, and alcohol consumption (QI 4). Additional data included sociodemographics, comorbidities, and number of rheumatology and primary care visits. QI compliance versus noncompliance was compared using chi-square analyses and independent-groups t-test. Results. In 2,280 gout patients, compliance with QI was as follows: QI 1: 92.1%, QI 2: 44.8%, and QI 3: 7.7%. Patients compliant with QI 2 had more rheumatology visits at 3.5 versus 2.6 visits (P < 0.001), while those compliant with QI 3 had more CKD (P < 0.01). Of 1,576 eligible patients, BM counseling for weight loss occurred in 1,008 patients (64.0%), low purine diet in 390 (24.8%), alcohol abstention in 137 (8.7%), and all 3 elements in 51 patients (3.2%). Regular rheumatology clinic visits correlated with frequent advice on weight loss and gout-specific diet (P < 0.0001). Conclusion. Rheumatology clinic attendance was associated with greater QI compliance. NLP proved a valuable tool for measuring BM as documented in the clinical narrative of EMRs.

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Evaluation of allopurinol use in patients with gout

Cited by 6 publications

References 0 publications

Allopurinol is the most common cause of Stevens-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel

Allopurinol is the most common cause of Stevens-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel

Efficacy and safety of desensitization to allopurinol following cutaneous reactions

Measuring Physician Adherence With Gout Quality Indicators: A Role for Natural Language Processing

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