Guideline adherence of xanthine oxidase inhibitor utilization to treat gout in primary care.

IF 2.9 4区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of managed care & specialty pharmacy Pub Date : 2025-09-01 DOI:10.18553/jmcp.2025.31.9.922

Liza W Claus, Madison E Auten, Joseph J Saseen, Sarah J Billups

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引用次数: 0

Abstract

Background: Gouty arthritis affects 3.9% of American adults and can be effectively managed using urate-lowering therapy initiated at a low dose and titrated to achieve a serum urate of less than 6 mg/dL, the "treat-to-target" approach. This approach is often underused in primary care (PC) settings.

Objective: To identify the proportion of patients newly prescribed a xanthine oxidase inhibitor (XOI) who have their dose titrated to achieve a serum urate (SU) of less than 6 mg/dL.

Methods: This retrospective cohort analysis used prescription orders from administrative electronic health record (EHR) databases to identify adult patients with a diagnosis of gout who were newly prescribed an XOI inhibitor by a CU Medicine PC provider. The primary endpoint was the proportion of patients prescribed an XOI who had their dose up-titrated, achieved a target SU of less than 6 mg/dL, or experienced both of these within 6 months of their first XOI prescription date. Additionally, the number of incident gout flares within 12 months was compared between groups stratified by XOI up-titration performed and achievement of SU target, adjusting for confounders using logistic regression.

Results: Of 1,600 patients evaluated, 851 met eligibility criteria. Of these, 704 (83%) were male, 649 (76%) were White, and the average age was 59 years. Within 6 months, 179 patients (21%) had their XOI dose up-titrated and 239 (28%) achieved an SU of less than 6 mg/dL; 66 patients (8%) had their XOI dose up-titrated and achieved an SU of less than 6 mg/dL within 6 months. 113 patients experienced gout flare, with SU less than 6 mg/dL associated with lower odds of flare (OR = 0.41, 0.23-0.71).

Conclusions: Within a university-based PC population, the proportion of patients newly prescribed an XOI receiving up-titration or achieving SU less than 6 mg/dL within 6 months of medication initiation is low, suggesting that a treat-to-target approach is underused.

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黄嘌呤氧化酶抑制剂在初级保健中治疗痛风的指南依从性。

背景：痛风性关节炎影响3.9%的美国成年人，可以通过低剂量的降尿酸治疗有效地管理，并滴定到低于6 mg/dL的血清尿酸，即“治疗到目标”的方法。这种方法在初级保健（PC）环境中往往未得到充分利用。目的：确定在新开黄嘌呤氧化酶抑制剂（xxi）的患者中，滴定剂量以达到血清尿酸（SU）低于6 mg/dL的比例。方法：本回顾性队列分析使用来自行政电子健康记录（EHR）数据库的处方单，以确定由CU医学PC提供者新开的XOI抑制剂的成年痛风患者。主要终点是服用XOI的患者的比例，他们的剂量增加了，达到了低于6mg /dL的目标SU，或者在他们的第一次XOI处方日期的6个月内经历了这两种情况。此外，比较按XOI上滴定和SU目标实现分层的组之间12个月内发生痛风的次数，并使用逻辑回归对混杂因素进行调整。结果：在评估的1600例患者中，851例符合资格标准。其中男性704例（83%），白人649例（76%），平均年龄59岁。在6个月内，179名患者（21%）的XOI剂量上调，239名患者（28%）的SU低于6mg /dL；66例（8%）患者的XOI剂量增加，并在6个月内达到低于6mg /dL的SU。113例患者出现痛风发作，SU低于6 mg/dL与发作几率较低相关（OR = 0.41, 0.23-0.71）。结论：在以大学为基础的PC人群中，新开XOI的患者在开始用药6个月内接受上升滴定或SU低于6 mg/dL的比例很低，这表明治疗到目标的方法未得到充分利用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of managed care & specialty pharmacy Health Professions-Pharmacy

CiteScore

3.50

自引率

4.80%

发文量

131

期刊介绍： JMCP welcomes research studies conducted outside of the United States that are relevant to our readership. Our audience is primarily concerned with designing policies of formulary coverage, health benefit design, and pharmaceutical programs that are based on evidence from large populations of people. Studies of pharmacist interventions conducted outside the United States that have already been extensively studied within the United States and studies of small sample sizes in non-managed care environments outside of the United States (e.g., hospitals or community pharmacies) are generally of low interest to our readership. However, studies of health outcomes and costs assessed in large populations that provide evidence for formulary coverage, health benefit design, and pharmaceutical programs are of high interest to JMCP’s readership.