Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Serum Uric Acid Testing Patterns In Gout Patients: A Need for Improved Monitoring.
Becker1, Michael A., Pandya2, Bhavik J., Young3, Jason R., Ye3, Xiangyang, Unni3, Sudhir, Yu2, Shawn, Asche3, Carl V.
Hyperuricemia (serum urate level [sUA] >6.8 mg/dL) is the major pathogenetic factor in gout. Reducing sUA to subsaturating levels (usually recommended as <6.0 mg/dL) is an important goal for therapy. When goal range sUA is maintained long-term, urate crystal deposition ceases and even reverses, with eventual clinical benefits including reduction in gout flares, resolution of tophi, reduced pain, and improved physical function and quality of life. Monitoring of sUA is important for optimal long-term gout management, because it allows detection of the need for medication adjustment or confirms that chronic therapy is appropriate. Since stable levels of sUA are established within 2 to 4 weeks after initiation or escalation of oral urate-lowering therapy (ULT) with agents such as allopurinol and febuxostat, sUA measurement at biweekly to monthly intervals is an effective means to monitor ULT dose titration. Once goal range sUA is established, less monitoring is appropriate, but annual assessment of sUA in gout patients (pts) on ULT is frequently recommended. The purpose of this study was to evaluate current sUA testing patterns in gout pts in a real-world setting.
This retrospective study used an ambulatory care-based electronic medical record database with health records of primary care pts. Pts >=18 years with diagnosis of gout (ICD-9 code 274.xx) and a prescription for allopurinol (ALLO) or febuxostat (FEB) from April 1, 2009 to Dec 31, 2009 and with 13+ months of database activity prior to and >=6 months of activity after index date (first Rx of ALLO or FEB) were included. Pts with a diagnosis of neoplasm or with an Rx >=2 ULTs on index date were excluded.
The study included 17,542 ALLO-treated pts (mean age 65±12 years, 76% male) and 394 FEB-treated pts (mean age 62±13 years, 75% male). Of the 17,936 total pts included in the study, 7,998 (44.6%) had at least 1 sUA measurement in the year prior to index date. Only 4,721 (26.3%) pts had both a pre-index (within 1 year) and follow-up (anytime after index) sUA measurement. Of 564 ALLO-treated pts whose dose was adjusted at index date, 165 (29.3%) had a follow-up sUA measure reported. For those pts receiving a dosage escalation (378 patients), 95 (25.1%) had a subsequent sUA measurement compared with 70 of 186 pts (37.6%) who had the ALLO dose reduced. Median time to the first follow-up sUA was 56 days (mean: 67 days) for pts with a dose escalation and 73 days (mean: 71 days) for pts with a dose decrease. For the 394 FEB-treated pts, 216 (54.8%) had a follow-up sUA measure at a median time of 44 days (mean: 59 days).
Based on real-world data, sUA monitoring is not adequate for the majority of gout pts. As sUA measurement is the only immediate means to determine the effectiveness of therapy (clinical benefit is usually not apparent for many months to several years), improved sUA testing patterns could favorably influence the quality of care for gout pts by identifying those not at goal and allowing appropriate adjustments to ULT. The establishment of sUA testing pattern guidelines may improve testing patterns.
To cite this abstract, please use the following information:
Becker, Michael A., Pandya, Bhavik J., Young, Jason R., Ye, Xiangyang, Unni, Sudhir, Yu, Shawn, et al; Serum Uric Acid Testing Patterns In Gout Patients: A Need for Improved Monitoring. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2048