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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

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Abstract

Introduction/objectives

Lifelong urate-lowering therapy (ULT) with xanthine oxidase inhibitors (XOIs), such as allopurinol and febuxostat, is the cornerstone of gout treatment. This study aimed to compare drug persistence between allopurinol and febuxostat as first-line ULT in patients with gout in real practice.

Method

In this retrospective cohort study, we evaluated 602 patients with gout in whom allopurinol or febuxostat was newly initiated from December 2011 to November 2018 at a tertiary rheumatology centre. Persistence was defined as the duration from the first description date to the end of treatment with XOIs or the end of the study period (November 2019).

Results

Among the 602 gout patients, the mean age was 60.2 years and 234 (38.9%) patients had tophi. Allopurinol and febuxostat were started in 237 (39.3%) and 365 (60.6%) patients, respectively. During the study period, 282 (46.8%) patients stopped taking XOIs, and the most common reason for XOI withdrawal was poor health literacy (61.3%). The 1- and 5-year persistence rates of XOIs were 67.2% and 40.9%, respectively. In the Kaplan–Meier analysis, persistence rates of allopurinol were significantly lower than those of febuxostat (p < 0.001). In the multivariable Cox regression model, allopurinol use was a significant risk factor for discontinuation of XOIs (HR = 2.01, p < 0.001). In addition, the presence of tophi and symptom duration < 24 months was independently associated with a higher risk of XOI withdrawal.

Conclusions

Long-term persistence of XOIs was suboptimal, and allopurinol had worse persistence rates than febuxostat among patients with gout.

Key Points

• Long-term persistence of xanthine oxidase inhibitors (XOIs) as first-line urate-lowering therapy (ULT) among patients with gout was suboptimal, and the major reason for XOI discontinuation was poor health literacy in our study.

• We demonstrated that allopurinol had worse persistence rates than febuxostat among patients with gout, suggesting that febuxostat is a better option for long-term ULT in light of medication adherence in a real-world setting.

• Patients with gout with tophi and shorter symptom duration were found to be at high risk for poor persistence of XOIs.

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Data Availability

The datasets used and/or analysed in the present study are available from the corresponding author on reasonable request.

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Acknowledgments

We specially thank the late Professor Sung-Il Kim who devoted himself to education, research, and patient care in Division of Rheumatology, Department of Internal Medicine, Pusan National University School of Medicine (1963 to 2011).

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, 179 Gudeok-Ro, Seo-Gu, Busan, 49241, South Korea

    Aran Kim & Seung-Geun Lee

  2. Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea

    Aran Kim & Seung-Geun Lee

  3. Division of Rheumatology, Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea

    Yunkyung Kim & Geun-Tae Kim

  4. Division of Rheumatology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea

    Eunyoung Ahn & Min Wook So

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  1. Aran Kim
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  3. Geun-Tae Kim
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Contributions

A Kim: study design, data collection and analysis and writing manuscript, YK Kim: data interpretation, GT Kim: data interpretation and revision of manuscript, MW So: data interpretation and revision of manuscript, E Ahn: data interpretation, SG Lee: study design, data analysis and interpretation, writing manuscript and coordination of entire study.

Corresponding author

Correspondence to Seung-Geun Lee.

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Ethical approval

Ethical approval was obtained via the Research and Ethical Review Board of Pusan National University Hospital, which waived informed consent due to retrospective study design (IRB no. 1912–021-086).

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Kim, A., Kim, Y., Kim, GT. et al. Comparison of persistence rates between allopurinol and febuxostat as first-line urate-lowering therapy in patients with gout: an 8-year retrospective cohort study. Clin Rheumatol 39, 3769–3776 (2020). https://doi.org/10.1007/s10067-020-05161-w

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