The American College of Physicians and the 2017 guideline for the management of acute and recurrent gout: treat to avoiding symptoms versus treat to target

Jansen, Tim; Janssen, Matthijs

doi:10.1007/s10067-017-3840-1

Cited by 11 publications

(4 citation statements)

References 14 publications

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“…Although we can only speculate on the reasons for poor adherence, we found that patients whose initial prescriber of ULT was a rheumatologist had better treatment adherence. This suggests that establishing local networks between rheumatologists and general practitioners, as previously suggested in an editorial in this journal, may be helpful for enhancing gout care [17]. Such initiatives, and in particular their influence on medication adherence, should be investigated in The Netherlands.…”

Section: Discussionmentioning

confidence: 98%

A retrospective analysis of medication prescription records for determining the levels of compliance and persistence to urate-lowering therapy for the treatment of gout and hyperuricemia in The Netherlands

et al. 2018

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Urate-lowering therapy (ULT) is a recommended life-long treatment for gout patients. However, despite these recommendations, recurrent gout attacks are commonly observed in clinical practice. The purpose of this study was to assess the levels of compliance and persistence to ULT in The Netherlands, in order to reflect on the current gout care delivered by health professionals. Anonymous prescription records were obtained from IQVIA’s Dutch retrospective longitudinal prescription database, containing ULT dispensing data for allopurinol, febuxostat, and benzbromarone from November 2013 to July 2017. Compliance to ULT was determined by calculating the proportion of days covered (PDC) over 12 months. Persistence over 12 months was evaluated by determining the time to discontinuation, without surpassing a refill gap of > 30 days. Association of PDC and persistence with age, gender, and first prescriber were examined using beta regression- and cox-regression models, respectively. There were 45,654 patients who met the inclusion criteria. Overall, 51.7% of the patients had a ULT coverage of ≥ 80% of the days in 1 year (PDC ≥ 0.80), and 42.7% of the patients were still persistent after 1 year. Men, older patients, and patients whose first prescriber was a rheumatologist were more persistent and had a higher PDC. Our results show that medication adherence to ULT after 1 year is suboptimal, considering that current guidelines recommend ULT as a life-long treatment. Future studies addressing the reasons for treatment cessation and improving treatment adherence seem warranted.

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Section: Discussionmentioning

confidence: 98%

A retrospective analysis of medication prescription records for determining the levels of compliance and persistence to urate-lowering therapy for the treatment of gout and hyperuricemia in The Netherlands

et al. 2018

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“…The "CDC Guideline for Prescribing Opioids for Chronic Pain-United States, 2016" underlines the harms associated with opioid use and recommends pursuing alternative options for managing CNCP [1]. The 2017 American College of Physicians guidelines recommend that physicians should consider treatment with Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) as first-line therapy, and tramadol or duloxetine as second-line therapy, in patients with chronic LBP who have had an inadequate response to non-pharmacologic therapy [7]. The 2016 NICE guidelines suggest weak opioids as a second-line treatment when NSAIDs are contraindicated, ineffective, or not tolerated [8].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Opioid Prescribing for Non-Malignant Low Back Pain in an Italian Primary Care Setting

Cammarota¹,

Conti

Corbi

et al. 2021

JCM

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This study explores which patient characteristics could affect the likelihood of starting low back pain (LBP) treatment with opioid analgesics vs. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in an Italian primary care setting. Through the computerized medical records of 65 General Practitioners, non-malignant LBP subjects who received the first pain intensity measurement and an NSAID or opioid prescription, during 2015–2016, were identified. Patients with an opioid prescription 1-year before the first pain intensity measurement were excluded. A multivariable logistic regression model was used to determine predictive factors of opioid prescribing. Results were reported as Odds Ratios (ORs) with a 95% confidence interval (CI), with p < 0.05 indicating statistical significance. A total of 505 individuals with LBP were included: of those, 72.7% received an NSAID prescription and 27.3% an opioid one (64% of subjects started with strong opioid). Compared to patients receiving an NSAID, those with opioid prescriptions were younger, reported the highest pain intensity (moderate pain OR = 2.42; 95% CI 1.48–3.96 and severe pain OR = 2.01; 95% CI 1.04–3.88) and were more likely to have asthma (OR 3.95; 95% CI 1.99–7.84). Despite clinical guidelines, a large proportion of LBP patients started with strong opioid therapy. Asthma, younger age and pain intensity were predictors of opioid prescribing when compared to NSAIDs for LBP treatment.

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“…Suboptimal treatment has been attributed to an underestimation of the burden of gout by professionals and patients, resulting in delays and poor adherence to treatment (18). Additionally, the lack of evidence about the optimal target and most effective drug strategy, creating distrust in guidelines, and limited attention for adherence to treatment have been identified by health care professionals as other barriers to optimal treatment (11,19,20).…”

Section: Introductionmentioning

confidence: 99%

Comparative Study of Real‐Life Management Strategies in Gout: Data From Two Protocolized Gout Clinics

Kampe

Durme

Janssen

et al. 2020

Arthritis Care & Research

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Objective. To compare outcomes of 2 gout clinics that implemented different treatment strategies. Methods. Patients newly diagnosed with gout and a follow-up of 9-15 months were included. Co-primary outcomes were the proportion of patients reaching a serum uric acid (UA) ≤0.36 mmoles/liter and free of flares. Secondary outcomes were the proportion of patients requiring treatment intensification and experiencing adverse events. One clinic adopted a strict serum UA (≤0.30 mmoles/liter target) strategy, with early addition of a uricosuric to allopurinol, and the other clinic adopted a patient-centered (PC) strategy emphasizing a shared decision based on serum UA and patient satisfaction with gout control. Independent t-tests or chi-square tests were used to test differences in outcomes, and logistic regressions were used to adjust the effect of the treatment center on outcomes for confounders.Results. In total, 126 and 86 patients had a follow-up mean ± SD of 11.3 ± 1.8 versus 11.1 ± 1.9 months. In the UA strategy, 105 of 126 patients (83%) compared to 63 of 86 (74%) in the PC strategy (P = 0.10) reached the threshold of ≤0.36 mmoles/liter; and 58 of 126 (46%) versus 31 of 86 (36%) were free of flares (P = 0.15). In the UA strategy, 76 of 126 patients (60%) were on allopurinol monotherapy compared to 63 of 86 (73%) in the PC strategy (P = 0.05), yet the number of adverse events was not different (n = 25 [20%] versus n = 20 [23%]; P = 0.55). Adjusting for confounders did not substantially change these associations. Conclusion.A strict UA strategy resulted in a nonsignificantly higher proportion of patients reaching a serum UA ≤0.36 mmoles/liter and being free of flares. This result was accomplished with significantly more therapy intensification. The small sample size plays a role in the significance of results.

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The American College of Physicians and the 2017 guideline for the management of acute and recurrent gout: treat to avoiding symptoms versus treat to target

Cited by 11 publications

References 14 publications

A retrospective analysis of medication prescription records for determining the levels of compliance and persistence to urate-lowering therapy for the treatment of gout and hyperuricemia in The Netherlands

A retrospective analysis of medication prescription records for determining the levels of compliance and persistence to urate-lowering therapy for the treatment of gout and hyperuricemia in The Netherlands

Predictors of Opioid Prescribing for Non-Malignant Low Back Pain in an Italian Primary Care Setting

Comparative Study of Real‐Life Management Strategies in Gout: Data From Two Protocolized Gout Clinics

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