Gout: prevalence up, drug compliance down

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Gout: prevalence up, drug compliance down

Rheumawire

Aug 12, 2004

Janis

Lake Forest, IL - Prevalence of gout and/or hyperuricemia increased

significantly over the past 10 years, especially among older patients;

however, compliance with allopurinol therapy remains poor, according to

a retrospective analysis of managed-care patients reported by Dr Katrine

L Wallace (Ingenix Pharmaceutical Services, Salt Lake City, UT) in the

August 2004 issue of the Journal of Rheumatology [1,2].

" An interesting finding of the study was that the gap with respect to

the burden of disease between women and men begins to close at the

oldest ages, as gout also increased over time in women, a clinically

important finding, since rheumatologists may not automatically diagnose

and treat gout in a female patient. This is particularly true as serum

urate is not part of a standard chemistry panel, " Wallace tells

rheumawire.

Untreated gout can lead to recurrent gouty arthritis, chronic gouty

arthropathy, tophi, and urolithiasis. Wallace and colleagues examined

gout prevalence and compliance with allopurinol therapy from 1990 to

1999 by using managed-care claims data for about 8 million patients in

21 network plans.

Prevalence rates were calculated for each year as rates per 1000

enrollees. This showed that the prevalence of gout and/or hyperuricemia

increased by about 2 cases per 1000 enrollees over 10 years in the

overall population. However, in the >75 age group, gout prevalence

increased from 21 per 1000 persons in 1990 to 41 per 1000 in 1999, and

in those aged 65 to 74, prevalence increased from between 21 and 24 per

1000 to over 31 per 1000.

Although gout is primarily thought of as a disease of males, it is

becoming increasingly common among women. In patients under 65, men had

4 times the prevalence of gout as women, while in those over 65 the

prevalence ratio narrowed to 3 to 1.

" Although the overall prevalence of gout among women has been increasing

since 1990, rates among women over age 65 seem to have decreased since

1997, " the researchers write. " Men, however, continue to show an upward

trend. . . . That gout prevalence has increased among women is vital

information for medical professionals. "

The same database showed that patients were noncompliant with

allopurinol therapy for an average of 44% of their treatment periods.

Wallace reported that of the patients who filled at least 1 prescription

for allopurinol during the 24-month study period, 10.4% filled 1

prescription and discontinued use, 13.7% never achieved compliance, and

only 18% were compliant throughout the entire study period [2].

The researchers point out that successful gout treatment usually

involves treatment of acute inflammation, prophylaxis against acute

attacks during the interval between attacks, and long-term restoration

of normal uric-acid levels, usually with an antihyperuricemic agent such

as allopurinol or uricosuric agents such as probenecid or

sulfinpyrazone.

The researchers suggest that 1 factor contributing to the low compliance

is " absence of widely accepted management guidelines for gout, resulting

in the limited ability of prescribing physicians to communicate to

patients the distinct aims and means of treatment. "

Wallace said that 2 very important risk factors for gout are obesity and

increasing age. " Epidemiologists have been reporting epidemics of

obesity in every subpopulation in the US, which leads one to believe

that conditions associated with this risk factor would also increase. In

addition, life expectancy continues to rise, in tandem with age-related

chronic conditions such as gout. "

Sources

Wallace KL, Riedel AA, ph-Ridge N, Wortmann R.

Increasing prevalence of gout and hyperuricemia over 10 years among

older adult in a managed care population. J Rheumatol 2004;

31:1582-1587.

Riedel AA, M, ph-Ridge N, Wallace K, et al.

Compliance with allopurinol therapy among managed care enrollees with

gout: a retrospective analysis of administrative claims. J Rheumatol

2004; 31:1575-1581.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org