Exposure to Allopurinol and the Risk of Cataract Extraction in Elderly Patients

Garbe, Edeltraut

doi:10.1001/archopht.116.12.1652

Cited by 22 publications

(6 citation statements)

References 26 publications

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“…Previous studies have reported that long-term administration of allopurinol increases the odds of cataract extraction in elderly patients. [ 24 ] Another study showed long-term ingestion of allopurinol to be related to the development of lens opacity in relatively young patients. [ 25 ] Lerman et.al[ 26 ] reported that allopurinol only had cataractogenic activity n patients in whom the drug had become photobound within the lens, which indicates the influence of the relationship between ultraviolet radiation exposure and circulating allopurinol levels in the genesis of photosensitized allopurinol cataracts.…”

Section: Discussionmentioning

confidence: 99%

The association between gout and cataract risk: A meta-analysis

et al. 2017

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PurposeTo evaluate the relationship between gout and age-related cataracts (ARCs).MethodsA comprehensive literature search of the PubMed and Web of Science databases was conducted to identify papers on the association between gout and cataract risk that had been published between February 1991 and January 2017. Pooled relative risks (RRs) or odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated. The random-effects model was used instead of the fixed-effects model when heterogeneity was identified, as indicated by a Cochran’s Q statistic P-value <0.10 or I2 index score >50%.ResultsA total of 3 cross-sectional studies and 3 case-control studies were included in the meta-analysis. Gout was significantly associated with increased odds of ARCs (OR 1.53, 95% CI 1.27–1.84). In the subgroup analysis, gout exhibited positive associations with the odds of posterior subcapsular cataracts (PSCs, OR 1.69, 95% CI: 1.06–2.70) and cortical cataracts (CCs, OR 1.39, 95% CI: 1.06–1.81). However, no association was identified between gout and the odds of nuclear cataracts.ConclusionsThe current literature suggested that gout may be associated with increased odds of ARCs, especially PSCs and CCs. Further efforts should be made to confirm these findings and clarify the effect of gout and gout medications on the development of cataracts.

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Section: Discussionmentioning

confidence: 99%

The association between gout and cataract risk: A meta-analysis

et al. 2017

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“…About 97% of the eligible population was registered under this plan in 1990. The databases maintained by the RAMQ for administrative purposes have found extensive use in pharmaco‐epidemiological research [12, 13, 17, 18], and a recent study [19] established that they were comprehensive and valid for this purpose. The drug database includes information on the name of the drug, date of filling the prescription, dosage, format, quantity dispensed, and duration for which the drug was prescribed.…”

Section: Methodsmentioning

confidence: 99%

Inhaled corticosteroids and the risk of diabetes among the elderly

Dendukuri

Blais

LeLorier

2002

Brit J Clinical Pharma

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Aims There is evidence that large doses of inhaled corticosteroids lead to an increased risk of glaucoma, cataracts and other problems associated with oral corticosteroid use. However, no formal investigation so far has been conducted into the relationship between inhaled corticosteroids and diabetes. Methods Our nested case-control design studied the association between current use of inhaled corticosteroids and the risk of using antidiabetic medications among a cohort of 21 645 elderly subjects. We also investigated the possibility of a doseresponse relationship in users of beclomethasone. Data were obtained from the medical and pharmaceutical databases of the Regie de l'assurance maladie du Québec.Results Within the cohort, we identified 1494 cases and we selected 14 931 controls using density sampling. The unadjusted rate ratio (and 95% confidence interval, CI) for developing diabetes among current users of inhaled corticosteroids was 1.4 (1.2, 1.5). After adjusting for covariates, the rate ratio (95% CI) decreased to 0.9 (0.8, 1.1). The loss of statistical significance was due in large part to adjusting for the current use of oral corticosteroids. We also did not observe a statistically significant increase in risk among users of high-dose beclomethasone compared to nonusers, after adjusting for covariates. Conclusions Our results do not indicate an increased risk of diabetes among current users of inhaled corticosteroids.

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“…45 In an economic analysis allopurinol, selected as the prototype and most widely used urate lowering drug, was shown to be more effective (72% v 5% acute attacks averted per year) and more costly than non-urate lowering drug treatment ($426.27 v 267.27 per patient per year). 80 ICER (cost per acute attack averted) was $247.40 at base case scenario, and varied from $99.59 to $489.26 depending on patient characteristics and probability estimates.…”

Section: Strength Of Recommendation: 91 (95% CI 88 To 95)mentioning

confidence: 99%

EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee For International Clinical Studies Including Therapeutics (ESCISIT)

Zhang

Doherty²,

Bardin³

et al. 2006

Annals of the Rheumatic Diseases

1,144

830

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Objective: To develop evidence based recommendations for the management of gout. Methods: The multidisciplinary guideline development group comprised 19 rheumatologists and one evidence based medicine expert representing 13 European countries. Key propositions on management were generated using a Delphi consensus approach. Research evidence was searched systematically for each proposition. Where possible, effect size (ES), number needed to treat, relative risk, odds ratio, and incremental cost-effectiveness ratio were calculated. The quality of evidence was categorised according to the level of evidence. The strength of recommendation (SOR) was assessed using the EULAR visual analogue and ordinal scales. Results: 12 key propositions were generated after three Delphi rounds. Propositions included both nonpharmacological and pharmacological treatments and addressed symptomatic control of acute gout, urate lowering therapy (ULT), and prophylaxis of acute attacks. The importance of patient education, modification of adverse lifestyle (weight loss if obese; reduced alcohol consumption; low animal purine diet) and treatment of associated comorbidity and risk factors were emphasised. Recommended drugs for acute attacks were oral non-steroidal anti-inflammatory drugs (NSAIDs), oral colchicine (ES = 0.87 (95% confidence interval, 0.25 to 1.50)), or joint aspiration and injection of corticosteroid. ULT is indicated in patients with recurrent acute attacks, arthropathy, tophi, or radiographic changes of gout. Allopurinol was confirmed as effective long term ULT (ES = 1.39 (0.78 to 2.01)). If allopurinol toxicity occurs, options include other xanthine oxidase inhibitors, allopurinol desensitisation, or a uricosuric. The uricosuric benzbromarone is more effective than allopurinol (ES = 1.50 (0.76 to 2.24)) and can be used in patients with mild to moderate renal insufficiency but may be hepatotoxic. When gout is associated with the use of diuretics, the diuretic should be stopped if possible. For prophylaxis against acute attacks, either colchicine 0.5-1 mg daily or an NSAID (with gastroprotection if indicated) are recommended. Conclusions: 12 key recommendations for management of gout were developed, using a combination of research based evidence and expert consensus. The evidence was evaluated and the SOR provided for each proposition. D espite reasonable understanding of its pathogenesis and the availability of effective treatment, gout is often misdiagnosed or diagnosed late in its clinical course, and even when correctly diagnosed treatment is often suboptimal. For example, a recent cross sectional study showed that the prevalence of predefined mismanagement of gout (no drug treatment, analgesic alone, or urate lowering therapy without prophylaxis) was over two times greater with physician management than with patient self management.

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Exposure to Allopurinol and the Risk of Cataract Extraction in Elderly Patients

Cited by 22 publications

References 26 publications

The association between gout and cataract risk: A meta-analysis

The association between gout and cataract risk: A meta-analysis

Inhaled corticosteroids and the risk of diabetes among the elderly

EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee For International Clinical Studies Including Therapeutics (ESCISIT)

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