Background According to the 2012 ACR guidelines (1) anti-inflammatory prophylaxis is recommended when urate lowering drugs (ULDs) are initiated and should be continued if there is continuing gout activity and/or serum urate (SU) target has not been achieved.
Objectives To record prophylaxis using the CORRONA Gout Registry, evaluate according to the ACR guidelines and analyze whether differences in disease characteristics influenced use of prophylaxis.
Methods Gout patients in the Registry were divided into 2 groups: “on prophylaxis” versus “not on prophylaxis” at time of enrollment. If at time of enrollment the patient was on one of the following: oral colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), prednisone ≤10mg/d or an aninterleukin-1 inhibitor and did not have a flare the patient was considered “on prophylaxis”. It is possible that a patient in the ”not on prophylaxis” group could be on one of the aforementioned drugs due to drug dosage or flare at visit.
Student's two-sample t-test and Chi-square test (or Fisher's Exact test if cell size <5) were used to compare factors between the “on prophylaxis” and “not on prophylaxis” groups.
Results 1167 gout patients were available for analysis in the CORRONA Gout Registry. 436 (37.4%) were on prophylaxis and 731 (62.6%) were not on prophylaxis. Prophylaxis included: colchicine 69% (n=302), NSAIDs 34% (n=149) (ibuprofen (n=59), indomethacin (n=53), celexoxib (n=53), prednisone 19% (n=81), methylprednisolone 7% (n=17), and anakinra 3% (n=3). ULDs included: allopurinol 68% (n=796), febuxostat 15% (n=176), probenecid 2% (n=19) and pegloticase 0.1% (n=8)). 292 (67%) of patients on prophylaxis had disease duration ≥1 yr.
Patients “on prophylaxis” were more likely to have: gout duration <1 yr (n=144) (p=0.016);≥1 flare in yr previous to enrollment (p<0.001) and ≥1 health care utilizations in the last yr: emergency department (p=0.002); outpatient visit (p<0.001); or ≥1 flare but did not seek care (p<0.001). Patients “on prophylaxis” were more likely to have SU ≥6mg/dl (p=0.028); be on allopurinol doses >300mg/d (p=0.015) or febuxostat 80mg/d (p=0.001); have tophi (p=0.003); report pain >3 (p=0.039) and disease activity >10 (p<0.001) compared to patients “not on prophylaxis”.
Conclusions 37.4% of gout patients in the CORRONA Gout Registry were on prophylaxis. Colchicine (used by 69%) and NSAIDs (used by 34%) were the most common drugs used for prophylaxis.
Prophylaxis was significantly more common in patients with: higher disease burden: gout duration <1 yr; ≥1 flare in yr previous to enrollment; greater heath care utilization; higher ULD dose; tophi; greater disease activity reported and SU ≥6mg/dl. This was in agreement with the ACR guidelines which support prophylaxis in patients with continuing disease activity and/or in patients whose SU was ≥6mg/dl. Many patients on prophylaxis had disease duration ≥1 yr suggesting that further studies are needed to assess appropriate length of prophylaxis.
Our study highlights gout disease characteristics influencing use of prophylaxis and furthers our knowledge on current use of prophylaxis.
Khanna et al. Arthritis Care Res 2012;64:1447.
Acknowledgements This study is sponsored by CORRONA. Initial funding for the CORRONA Gout registry was provided by Savient Pharmaceuticals, Inc. In the last two years, AbbVie, Amgen, AstraZeneca, Genentech, Horizon Pharma, Lilly, Novartis, Pfizer, Savient, Vertex, and UCB have supported CORRONA through contracted subscriptions.
Disclosure of Interest N. Schlesinger Grant/research support: Novartis, Consultant for: Novartis, Sobi, Speakers bureau: Novartis, Takeda, Savient, C. Etzel Employee of: CORRONA, Inc. employee, J. Greenberg Shareholder of: CORRONA Inc., Consultant for: AstraZeneca and Pfizer, Employee of: CORRONA, Inc. employee, J. Kremer Shareholder of: CORRONA Inc., Employee of: CORRONA, Inc. employee, L. Harrold Grant/research support: Takeda, Astra Zeneca