Utilization of acute gout prophylaxis in the real world: a retrospective database cohort analysis

Abstract

Objective

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.

Methods

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.

Results

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).

Conclusion

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

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Availability of data and material

The authors confirm that the data supporting the findings of this study are available within the article.

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Acknowledgments

The statements, findings, conclusions, views, and opinions contained and expressed in this publication are based in part on data obtained under license from IQVIA™. Source: IQVIA™ Health Plan Claims Data (formerly known as Legacy PharMetrics), January 1, 2007–September 30, 2017, IQVIA™. All Rights Reserved. The statements, findings, conclusions, views, and opinions contained and expressed herein are not necessarily those of IQVIA™ or any of its affiliated or subsidiary entities.

The authors would like to thank R. Brett Mcqueen, PhD, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, who was involved in study design and review of results for this database analysis.

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Correspondence to Liza W. Claus.

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The study protocol was submitted to the Colorado Multiple Institutional Review Board (COMIRB) and was determined to be exempt.

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The study protocol was submitted to the Colorado Multiple Institutional Review Board (COMIRB) and was determined to be exempt

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Marina L. Maes was a PGY2 resident at the University of Colorado at the time this research project was conducted.

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Maes, M.L., Saseen, J.J., Wright, G. et al. Utilization of acute gout prophylaxis in the real world: a retrospective database cohort analysis. Clin Rheumatol 40, 1017–1026 (2021). https://doi.org/10.1007/s10067-020-05265-3

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Keywords

  • Colchicine
  • Gout
  • Gout flare
  • Gout suppressants
  • Prophylactic therapy
  • Xanthine oxidase inhibitor