An evaluation of the efficacy of drug dosing based on SUA levels in patients with repeat SUA levels: analysis of data from a linked database of laboratory and pharmacy claims data
Bernie McGowan1, Deepti Ranganathan1, Kath Bennett3, Carmel Silke1, Bryan Whelan1, 2
1North Western Rheumatology Unit, OLHM, Co. Leitrim 2Department of Medicine, NUIG, Galway 3Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, Dublin 8
EULAR1 and ACR2 guidelines recommend initiating ULT at a low dose (e.g. allopurinol at 100mg/day) and up-titrating the drug dose, so as to reach the target SUA level of <360 micromoles.
To identify if EULAR and ACR guidelines are adhered to in clinical practice in relation to appropriate dosing of allopurinol for the management of gout and to evaluate the efficacy of drug dosing based on SUA levels in patients with repeat SUA levels post initiation of treatment.
This was a retrospective study involving a combined data set of the HSE-PCRS database and hospital laboratory data linked using the patients HSE-PCRS number between January 2008 and December 2012. All patients included in the study were followed through for 12 months post initiation of therapy. Patients were stratified into 3 groups: 1) commenced on allopurinol 100mg and remained on 100mg, 2) commenced on allopurinol 300mg and remained on 300mg, 3) commenced on allopurinol 100mg and gradually up titrated to 300mg.
In total 9520 patients were identified as having a HSEPCRS number and included in the study. In total 620 (7%) of the HSE-PCRS patients had received any urate-lowering therapy between January 2008 and December 2012. Only 264 of the patients had at least 1-year follow-up of ULT. In total 107 (41%) patients had repeat SUA levelsl taken after baseline. Only 12 (4.3%) had follow-up uric acid test after baseline test and 6.5% were up titrated from 100mg to 300mg.
The results of our study do not demonstrate adherence to the current EULAR, ACR or NICE guidelines in the management of gout in the Irish setting.