Low allopurinol prescription rates and suboptimal dosing are of particular concern in adult patients in Asia with poorly controlled gout.
A new investigation identified nearly 30% of adult patients in a real-world cohort with gout had poor disease control, with demographic and comorbid risk factors including male gender, congestive heart failure, and Malay ethnicity.1
The investigative team from SingHealth Polyclinics, led by Prawira Oka, MD, highlighted the low allopurinol prescription rates and suboptimal dosing regimen as of particular concern for patients with poorly controlled gout.
“Overall, the low allopurinol prescription rates and suboptimal dosing in patients with poorly-controlled gout are of concern,” wrote Oka and colleagues. “Primary care physicians need to optimize urate-lowering therapy for their patients to regain and sustain gout control.”
Gout is associated with significant morbidity and mortality, but disease control remains suboptimal globally.2 Achieving serum uric acid targets is understood to reduce the frequency of acute gout attacks, but a large percentage of patients have not attained these targets. But, gout control, or lack thereof, has been associated with both modifiable and non-modifiable risk factors.
Demographic and clinical risk factors are factors that can influence gout control, as male gender is associated with the disease, and chronic kidney disease and congestive heart associated with an increased risk. Improved recognition of these epidemiological factors associated with gout could lead to the increased identification of at-risk patients and the development of targeted interventions for those with poor disease control.
Oka and colleagues analyzed both the prevalence of poor gout control and the associated demographic and clinical risk factors among urbanized community-dwelling adults in primary healthcare clinics in Singapore.1 The retrospective analysis extracted data from the electronic health records of patients with clinician-diagnosed gout and ≥2 visits to the clinics between January 2018 and December 2019.
The extracted data included socio-demographic factors, anthropological measurements, comorbidities, serum uric acid levels, and medication prescriptions. Socio-demographic factors included gender, age, ethnicity, smoking, and medical subsidy status. Associated comorbid conditions including congestive heart failure, CKD, diabetes, hyperlipidemia, hypertension, and ischemic heart disease were also collected.
A patient was considered to have poorly controlled gout if they suffered two or more gout attacks within a year period. An attack was defined as a clinic visit with an electronic medical record diagnosis of “gout” and a colchicine prescription not prescribed as prophylaxis or standby.
A total of 7,970 patients with gout, corresponding to 24,624 clinic visits between 2018 and 2019, were included in the analysis. Most patients were male (83.6%) and Chinese (76.8%) and had a mean age of 61.7 years.
Upon analysis, investigators found 28.2% (n = 2,244) of patients had poorly controlled gout. Of the population with poorly controlled disease, only 46.3% of patients (n = 1039) were prescribed allopurinol, with 13.4% (n = 301) taking doses ≥300mg.
After logistic regression, the analysis showed the factors associated with poor gout control were male gender (adjusted odds ratio [aOR], 1.66; P <.001), Malay ethnicity (aOR, 1.27; P = .007), congestive heart failure (aOR, 1.64; P = .037). In addition, those prescribed allopurinol (aOR, 1.52; P <.001), non-steroidal anti-inflammatory drugs (aOR, 2.76; P <.001), and corticosteroids (aOR, 2.83; P <.001) were more likely to have poorly controlled gout.
Oka and colleagues noted the low allopurinol prescription observed in the study is likely due to therapeutic inertia from both physicians and patients with gout, who may be concerned about the risk of allopurinol-induced severe cutaneous adverse reactions.
“Concerningly, allopurinol was only prescribed in approximately half of patients with poorly-controlled gout, placing these patients at increased morbidity and mortality risks,” investigators wrote.