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Meloche M, Pilon MO, Provost S, Leclair G, Oussaïd E, St-Jean I, Jutras M, Gaulin MJ, Lemieux Perreault LP, Valois D, Mongrain I, Busseuil D, Rouleau JL, Tardif JC, Dubé MP, de Denus S. A Genome-Wide Association Study of Oxypurinol Concentrations in Patients Treated with Allopurinol. J Pers Med 2024; 14:649. [PMID: 38929870 PMCID: PMC11204675 DOI: 10.3390/jpm14060649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Cohort studies have identified several genetic determinants that could predict the clinical response to allopurinol. However, they have not been commonly used for genome-wide investigations to identify genetic determinants on allopurinol metabolism and concentrations. We conducted a genome-wide association study of a prior cross-sectional investigation of patients from the Montreal Heart Institute Biobank undergoing allopurinol therapy. Four endpoints were investigated, namely plasma concentrations of oxypurinol, the active metabolite of allopurinol, allopurinol, and allopurinol-riboside, as well as allopurinol daily dosing. A total of 439 participants (mean age 69.4 years; 86.4% male) taking allopurinol (mean daily dose 194.5 mg) and who had quantifiable oxypurinol concentrations were included in the genome-wide analyses. Participants presented with multiple comorbidities and received concomitant cardiovascular medications. No association achieved the predefined genome-wide threshold values for any of the endpoints (all p > 5 × 10-8). Our results are consistent with prior findings regarding the difficulty in identifying genetic determinants of drug concentrations or pharmacokinetics of allopurinol and its metabolites, as well as allopurinol daily dosing. Given the size of this genome-wide study, collaborative investigations involving larger and diverse cohorts may be required to further identify pharmacogenomic determinants of allopurinol and measure their clinical relevance to personalize allopurinol therapy.
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Affiliation(s)
- Maxime Meloche
- Faculty of Pharmacy, Université de Montréal, Montreal, QC H3T 1J4, Canada
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada (D.B.)
- Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, QC H1T 1C8, Canada
| | - Marc-Olivier Pilon
- Faculty of Pharmacy, Université de Montréal, Montreal, QC H3T 1J4, Canada
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada (D.B.)
- Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, QC H1T 1C8, Canada
| | - Sylvie Provost
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada (D.B.)
- Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, QC H1T 1C8, Canada
| | - Grégoire Leclair
- Faculty of Pharmacy, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Essaïd Oussaïd
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada (D.B.)
- Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, QC H1T 1C8, Canada
| | - Isabelle St-Jean
- Faculty of Pharmacy, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Martin Jutras
- Faculty of Pharmacy, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Marie-Josée Gaulin
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada (D.B.)
- Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, QC H1T 1C8, Canada
| | - Louis-Philippe Lemieux Perreault
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada (D.B.)
- Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, QC H1T 1C8, Canada
| | - Diane Valois
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada (D.B.)
- Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, QC H1T 1C8, Canada
| | - Ian Mongrain
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada (D.B.)
- Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, QC H1T 1C8, Canada
| | - David Busseuil
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada (D.B.)
- Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, QC H1T 1C8, Canada
| | - Jean-Lucien Rouleau
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada (D.B.)
- Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada (D.B.)
- Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, QC H1T 1C8, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Marie-Pierre Dubé
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada (D.B.)
- Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, QC H1T 1C8, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Simon de Denus
- Faculty of Pharmacy, Université de Montréal, Montreal, QC H3T 1J4, Canada
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada (D.B.)
- Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, QC H1T 1C8, Canada
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Li Y, Merriman TR, Chen H, Lv Q, Yan Y, Xu X, Ji A, Cheng Z, Wang X, Lu D, Han L, Cui L, Wang C, Sun W, Li C, Lu J. Clinical characteristics of adolescent-onset gout in Chinese: A hospital-based cross-sectional study. Semin Arthritis Rheum 2024; 65:152405. [PMID: 38335695 DOI: 10.1016/j.semarthrit.2024.152405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/12/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Adolescent-onset gout has a greater impact on the lives and health of patients than adult-onset gout. However, there is a relative lack of clinical information on adolescent-onset gout. Hence, we analyzed a Chinese cohort. METHODS We studied clinical features of 9,003 Chinese patients. Gout onset age of 12 - 19 years is defined as adolescent-onset group (AG), 20 - 40 years as early-onset group (EG), and 41 - 64 years as late-onset group (LG). Multivariable regression analysis evaluated factors associated with recurrent flares, serum urate (SU) levels, and underexcretion type in AG. RESULTS Compared with EG and LG, the AG had higher SU levels [AG: 9.5 (2.2) mg/dL, EG: 8.6 (2.1) mg/dL, LG: 7.73 (2.0) mg/dL, P < 0.001], higher percentage of positive family history of gout (AG: 41.8 %, EG: 29.6 %, LG: 24.6 %, P < 0.001), underexcretion type (AG: 62.4 %, EG: 62.5 %, LG: 58.8 %, P = 0.04), recurrent flares (AG: 78.1 %, EG: 70.3 %, LG: 68.9 %, P = 0.01). Urate-lowering therapy (ULT) initiated [OR 6.58 (95 % CI 1.35 - 32.00)] and hypercholesterolemia [OR 4.16 (95 % CI 1.28 - 13.53)] were associated with recurrent flares. eGFR was identified to be a significant variable of increasing SU levels [beta -0.24 (95 % CI -0.04 to -0.01)]. Hypertriglyceridemia [OR 0.35 (95 % CI 0.17 - 0.71)] was related to underexcretion type. CONCLUSION Adolescent-onset gout patients had clinically distinctive features with higher SU levels, BMI, positive gout family history, underexcretion type and recurrent flares. These specific populations were less likely to achieve ULT target, requiring more clinical attention.
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Affiliation(s)
- Yushuang Li
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China; Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China; Institute of Metabolic Diseases, Qingdao University, 266003 Qingdao, PR China
| | - Tony R Merriman
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China; Institute of Metabolic Diseases, Qingdao University, 266003 Qingdao, PR China; Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Haibing Chen
- Department of Endocrinology and Metabolism, Shanghai 10th People's Hospital, Tongji University, 200072 Shanghai, PR China
| | - Qingguo Lv
- Department of Endocrinology and Metabolism, Center for diabetes and metabolism research, West China Hospital of Sichuan University, 610041 Chengdu, PR China
| | - Yinkun Yan
- Center for Non-communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045 Beijing, PR China
| | - Xinmiao Xu
- Department of Endocrinology and Metabolism, Yantai Yeda Hospital, 265599 Yantai, PR China
| | - Aichang Ji
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China
| | - Zan Cheng
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China
| | - Xiaxia Wang
- Department of Cardiology, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China
| | - Di Lu
- Department of the Third Chest, Qingdao Chest Hospital, 266043 Qingdao, PR China
| | - Lin Han
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China
| | - Lingling Cui
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China
| | - Can Wang
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China
| | - Wenyan Sun
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China
| | - Changgui Li
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China; Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China; Institute of Metabolic Diseases, Qingdao University, 266003 Qingdao, PR China
| | - Jie Lu
- Shandong Provincial Clinical Research Center for Immune Diseases and Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China; Department of Endocrinology and Metabolism, the Affiliated Hospital of Qingdao University, 266003 Qingdao, PR China; Institute of Metabolic Diseases, Qingdao University, 266003 Qingdao, PR China.
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Kamel B, Abuhelwa AY, Foster D, Duong JK, Graham GG, Williams KM, Pile KD, Day RO. Population pharmacokinetic modelling of febuxostat in healthy subjects and people with gout. Br J Clin Pharmacol 2022; 88:5359-5368. [PMID: 35849446 PMCID: PMC9796681 DOI: 10.1111/bcp.15462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 01/07/2023] Open
Abstract
AIMS To investigate and characterise the pharmacokinetics of febuxostat and the effect of the covariates of renal function and body size descriptors on the pharmacokinetics of the drug. METHODS Blood samples (n = 239) were collected using sparse and rich sampling strategies from healthy (n = 9) and gouty (n = 29) subjects. Febuxostat plasma concentrations were measured by a validated high-performance liquid chromatography method. Population pharmacokinetic analysis was performed using NONMEM. A common variability on bioavailability (FVAR) approach was used to test the effect of fed status on absorption parameters. Covariates were modelled using a power model. RESULTS The time course of the plasma concentrations of febuxostat is best described by a two-compartment model. In the final model, the population mean for apparent clearance (CL/F), apparent central volume of distribution (Vc/F), apparent peripheral volume of distribution (Vp/F), absorption rate constant (ka) and apparent intercompartmental clearance (Q/F) were 6.91 l h-1 , 32.8 l, 19.4 l, 3.6 h-1 and 1.25 l h-1 , respectively. The population parmater variability (coefficient of variation) for CL/F, Vc/F and Vp/F were 13.6, 22 and 19.5%, respectively. Food reduced the relative biovailability and ka by 67% and 87%, respectively. Renal function, as assessed by creatinine clearance, was a significant covariate for CL/F while body mass index was a significant covariate for Vc/F. CONCLUSIONS Renal function and body mass index were significant covariates. Further work is warranted to investigate the clinical relevance of these results, notably as renal impairment and obesity are common occurrences in people with gout.
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Affiliation(s)
- Bishoy Kamel
- The George Institute for Global HealthSydneyNew South WalesAustralia,St Vincent's Clinical SchoolUniversity of New South Wales SydneyNew South WalesAustralia,Department of Clinical Pharmacology and ToxicologySt Vincent's Hospital and University of New South Wales SydneyNew South WalesAustralia,School of Medical SciencesUniversity of New South Wales SydneyNew South WalesAustralia
| | - Ahmad Y. Abuhelwa
- College of PharmacyUniversity of SharjahSharjahUnited Arab Emirates,College of Medicine and Public HealthFlinders UniversitySouth AustraliaAustralia,Australian Centre for Precision Health, Clinical and Health SciencesUniversity of South AustraliaSouth AustraliaAustralia
| | - David Foster
- Australian Centre for Precision Health, Clinical and Health SciencesUniversity of South AustraliaSouth AustraliaAustralia
| | - Janna K. Duong
- Faculty of PharmacyThe University of SydneySydneyNew South WalesAustralia
| | - Garry G. Graham
- Department of Clinical Pharmacology and ToxicologySt Vincent's Hospital and University of New South Wales SydneyNew South WalesAustralia,School of Medical SciencesUniversity of New South Wales SydneyNew South WalesAustralia
| | - Kenneth M. Williams
- Department of Clinical Pharmacology and ToxicologySt Vincent's Hospital and University of New South Wales SydneyNew South WalesAustralia,School of Medical SciencesUniversity of New South Wales SydneyNew South WalesAustralia
| | - Kevin D. Pile
- Department of MedicineWestern Sydney UniversityNew South WalesAustralia,Department of Rheumatology, Campbelltown HospitalSydneyNew South WalesAustralia
| | - Richard O. Day
- St Vincent's Clinical SchoolUniversity of New South Wales SydneyNew South WalesAustralia,Department of Clinical Pharmacology and ToxicologySt Vincent's Hospital and University of New South Wales SydneyNew South WalesAustralia
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Rodríguez-Rovira I, Arce C, De Rycke K, Pérez B, Carretero A, Arbonés M, Teixidò-Turà G, Gómez-Cabrera MC, Campuzano V, Jiménez-Altayó F, Egea G. Allopurinol blocks aortic aneurysm in a mouse model of Marfan syndrome via reducing aortic oxidative stress. Free Radic Biol Med 2022; 193:538-550. [PMID: 36347404 DOI: 10.1016/j.freeradbiomed.2022.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Increasing evidence indicates that redox stress participates in MFS aortopathy, though its mechanistic contribution is little known. We reported elevated reactive oxygen species (ROS) formation and NADPH oxidase NOX4 upregulation in MFS patients and mouse aortae. Here we address the contribution of xanthine oxidoreductase (XOR), which catabolizes purines into uric acid and ROS in MFS aortopathy. METHODS AND RESULTS In aortic samples from MFS patients, XOR protein expression, revealed by immunohistochemistry, increased in both the tunicae intima and media of the dilated zone. In MFS mice (Fbn1C1041G/+), aortic XOR mRNA transcripts and enzymatic activity of the oxidase form (XO) were augmented in the aorta of 3-month-old mice but not in older animals. The administration of the XOR inhibitor allopurinol (ALO) halted the progression of aortic root aneurysm in MFS mice. ALO administrated before the onset of the aneurysm prevented its subsequent development. ALO also inhibited MFS-associated endothelial dysfunction as well as elastic fiber fragmentation, nuclear translocation of pNRF2 and increased 3'-nitrotyrosine levels, and collagen maturation remodeling, all occurring in the tunica media. ALO reduced the MFS-associated large aortic production of H2O2, and NOX4 and MMP2 transcriptional overexpression. CONCLUSIONS Allopurinol interferes in aortic aneurysm progression acting as a potent antioxidant. This study strengthens the concept that redox stress is an important determinant of aortic aneurysm formation and progression in MFS and warrants the evaluation of ALO therapy in MFS patients.
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Affiliation(s)
- Isaac Rodríguez-Rovira
- Department of Biomedical Sciences, University of Barcelona School of Medicine and Health Sciences, 08036, Barcelona, Spain
| | - Cristina Arce
- Department of Biomedical Sciences, University of Barcelona School of Medicine and Health Sciences, 08036, Barcelona, Spain
| | - Karo De Rycke
- Department of Biomedical Sciences, University of Barcelona School of Medicine and Health Sciences, 08036, Barcelona, Spain
| | - Belén Pérez
- Department of Pharmacology, Toxicology and Therapeutics, Neuroscience Institute, School of Medicine, Autonomous University of Barcelona, 08193, Cerdanyola del Vallès, Spain
| | - Aitor Carretero
- Department of Physiology, Faculty of Medicine, University of Valencia, CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
| | - Marc Arbonés
- Department of Biomedical Sciences, University of Barcelona School of Medicine and Health Sciences, 08036, Barcelona, Spain
| | - Gisela Teixidò-Turà
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER-CV, Vall d'Hebrón Institut de Recerca (VHIR), Barcelona, Spain
| | - Mari Carmen Gómez-Cabrera
- Department of Physiology, Faculty of Medicine, University of Valencia, CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
| | - Victoria Campuzano
- Department of Biomedical Sciences, University of Barcelona School of Medicine and Health Sciences, 08036, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, Spain
| | - Francesc Jiménez-Altayó
- Department of Pharmacology, Toxicology and Therapeutics, Neuroscience Institute, School of Medicine, Autonomous University of Barcelona, 08193, Cerdanyola del Vallès, Spain
| | - Gustavo Egea
- Department of Biomedical Sciences, University of Barcelona School of Medicine and Health Sciences, 08036, Barcelona, Spain.
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Shin A, Choi SR, Han M, Ha YJ, Lee YJ, Lee EB, Kang EH. Cardiovascular safety associated with febuxostat versus allopurinol among patients with gout: update with accumulated use of febuxostat. Semin Arthritis Rheum 2022; 56:152080. [DOI: 10.1016/j.semarthrit.2022.152080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 10/16/2022]
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O'Dell JR, Brophy MT, Pillinger MH, Neogi T, Palevsky PM, Wu H, Davis-Karim A, Newcomb JA, Ferguson R, Pittman D, Cannon GW, Taylor T, Terkeltaub R, Cannella AC, England BR, Helget LN, Mikuls TR. Comparative Effectiveness of Allopurinol and Febuxostat in Gout Management. NEJM EVIDENCE 2022; 1:10.1056/evidoa2100028. [PMID: 35434725 PMCID: PMC9012032 DOI: 10.1056/evidoa2100028] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The relative efficacy and safety of allopurinol and febuxostat when used according to current guidelines for the treatment of hyperuricemia are unknown. This double-blind noninferiority trial examined these issues. METHODS Participants with gout and hyperuricemia (with at least 33% having stage 3 chronic kidney disease) were randomly assigned to allopurinol or febuxostat in this 72-week trial, with doses titrated to target serum urate. The trial had three phases: titration (weeks 0 to 24), maintenance (weeks 25 to 48), and observation (weeks 49 to 72). Allopurinol and febuxostat were initiated at daily doses of 100 and 40 mg, with maximum titration to 800 and 120 mg, respectively. Antiinflammatory prophylaxis was given during phases 1 and 2. The primary end point was the proportion of patients experiencing one or more flares during phase 3, with a prespecified noninferiority margin of less than 8 percentage points between allopurinol and febuxostat. Secondary end points included efficacy in patients with chronic kidney disease, proportion achieving target serum urate levels, and serious adverse events. RESULTS This study included 940 participants; 20.1% withdrew, with similar proportions in treatment arms. During phase 3, 36.5% of allopurinol-treated participants had one flare or more compared with 43.5% of febuxostat-treated participants (P<0.001 for noninferiority). Overall, 80% of participants achieved mean target urates during phase 2 with no differences by treatment. There were no treatment differences (including cardiovascular events) in serious adverse events. CONCLUSIONS Allopurinol and febuxostat achieved serum urate goals in patients with gout; allopurinol was noninferior to febuxostat in controlling flares. Similar outcomes were noted in participants with stage 3 chronic kidney disease. (Funded by the Cooperative Studies Program of the Department of Veterans Affairs Office of Research and Development; ClinicalTrials.gov identifier, NCT02579096.).
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Affiliation(s)
- James R O'Dell
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, Nebraska
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Mary T Brophy
- VA Boston Cooperative Studies Program Coordinating Center, Boston
- School of Medicine, VA Boston Health Care System, Boston University, Boston
| | - Michael H Pillinger
- VA New York Harbor Health Care System, New York
- NYU Grossman School of Medicine, New York
| | | | - Paul M Palevsky
- VA Pittsburgh Health Care System, Pittsburgh
- University of Pittsburgh School of Medicine, Pittsburgh
| | - Hongsheng Wu
- VA Boston Cooperative Studies Program Coordinating Center, Boston
- Wentworth Institute of Technology, Boston
| | - Anne Davis-Karim
- VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM
| | - Jeff A Newcomb
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, Nebraska
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ryan Ferguson
- VA Boston Cooperative Studies Program Coordinating Center, Boston
| | - David Pittman
- VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM
| | - Grant W Cannon
- VA Salt Lake City Health Care System, University of Utah, Salt Lake City
| | - Thomas Taylor
- White River Junction VA Medical Center, White River Junction, VT
- Dartmouth Geisel School of Medicine, Hanover, NH
| | | | - Amy C Cannella
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, Nebraska
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Bryant R England
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, Nebraska
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Lindsay N Helget
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, Nebraska
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ted R Mikuls
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, Nebraska
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
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Emad Y, Dalbeth N, Weinman J, Chalder T, Petrie KJ. Why do patients with gout not take allopurinol? J Rheumatol 2022; 49:622-626. [DOI: 10.3899/jrheum.210950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
Objective The objectives of this study were to examine the reasons patients give for non-adherence to allopurinol and examine differences in intentional non-adherence for patients with and without serum urate at treatment target. Methods Sixty-nine men with gout attending rheumatology clinics, all prescribed allopurinol for at least six months, completed the Intentional Non-Adherence Scale (INAS). Differences in the types of intentional non-adherence were analysed between those with and without a serum urate (SU) at treatment target (<0.36mmol/L, 6mg/dL). Results Among most frequently endorsed reasons for not taking their urate lowering medication was because participants wanted to lead a normal life (23%) or think of themselves as a healthy person again (20%). Patients also reported not taking allopurinol as way of testing if they really needed it (22%). Participants with SU above target endorsed significantly more INAS items as reasons for not taking their medicine, had higher medicine-related concerns and were more likely to give testing treatment as a reason for non-adherence. Participants who were younger, single and non-NZ European also endorsed more reasons for not taking their allopurinol. Conclusion Major reasons behind the decision not to take allopurinol relate to wanting to lead a normal life and the strategy of testing treatment to see if patients could reduce the dose without getting symptoms. The results provide some potentially modifiable targets for adherence interventions and also some indications to clinicians about how urate-lowering treatment may be purposely framed for patients in order to improve adherence.
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Quilisadio JEC, Salido EO, Penserga EG. Achievement of the target serum urate level among patients with gout treated with allopurinol or febuxostat in an arthritis clinic in the Philippines. Mod Rheumatol 2020; 31:755-761. [PMID: 32701037 DOI: 10.1080/14397595.2020.1800557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Gout is an important cause of disability among Filipinos, despite measures for effective management. This study aims to determine attainment of target serum uric acid level (SUA ≤ 6 mg/dl) among patients with gout given urate-lowering therapy (ULT) over 6-12 months. METHODS This is a single-center, prospective cohort study conducted in one adult Arthritis Clinic at the University of the Philippines-Philippine General Hospital which included 138 patients with gout (1977 ACR criteria), SUA ≥ 6 mg/dl prior to ULT, initiated on ULT (allopurinol or febuxostat), with six months minimum follow-up and with SUA determination post-treatment. RESULTS 37.7% (52/138) and 36.2% (50/138), achieved target SUA at 6 and 12 months. The factors associated with achieving target SUA in 6 months are BMI > 25 kg/m2 [OR 6.98, 95% confidence interval (CI) 1.44-33.88, p value = .016], allopurinol dose ≥ 300 mg (OR 15.76, 95% CI 2.24-111.06, p value = .006), and baseline SUA (OR 0.52, 95% CI 0.33-0.82, p value = .005). The factors associated with achieving target SUA in 12 months are employment (OR 5.51, 95% CI 1.00-30.33, p value = .050), baseline SUA (OR 0.45, 95% CI 0.28-0.74, p value = .002), and age at onset of gout (OR 1.08, 95% CI 1.01-1.15, p value = .026). CONCLUSION Target SUA level was not achieved at 6 and 12 months of ULT in most of this cohort. This mirrors the deficient control of gout and should urge health professionals to fully study and address the problem.
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Affiliation(s)
- John Elmer Cabang Quilisadio
- Division of Rheumatology, Department of Medicine, University of the Philippines Manila, Philippine General Hospital, Manila, Philippines
| | - Evelyn Osio Salido
- Division of Rheumatology, Department of Medicine, University of the Philippines Manila, Philippine General Hospital, Manila, Philippines
| | - Ester Gonzales Penserga
- Division of Rheumatology, Department of Medicine, University of the Philippines Manila, Philippine General Hospital, Manila, Philippines
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Toroghi MK, Cluett WR, Mahadevan R. A Personalized Multiscale Modeling Framework for Dose Selection in Precision Medicine. Ind Eng Chem Res 2020. [DOI: 10.1021/acs.iecr.0c01070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Masood Khaksar Toroghi
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada, M5S 3E5
| | - William R. Cluett
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada, M5S 3E5
| | - Radhakrishnan Mahadevan
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada, M5S 3E5
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada, M5S 3E5
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Löffler W, Fairbanks L. Refractory gout - does it exist? NUCLEOSIDES NUCLEOTIDES & NUCLEIC ACIDS 2020; 39:1410-1423. [PMID: 32352349 DOI: 10.1080/15257770.2020.1746804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Refractory gout (RG) has been increasingly recognized to be a major problem in clinical care. Patients diagnosed with RG have been assumed to be non-adherent, or under-dosed, to the greater part. In a minority, pathophysiological mechanisms have been discussed. During the last two decades, however, none of the studies differentiated non-adherence from impaired response to drug treatment. A definition of adherence has been proposed in the case of allopurinol treatment (oxipurinol in serum, >20 µmol/l), which would seem to confirm a dose of about 50 mg/d being taken by the patients. Guidelines for treating gout published by national or international rheumatology societies do provide very little, if any, information on how to evaluate patients with RG. Coinciding with the development of the xanthine oxidase inhibitor, febuxostat, a moderate increase in the number of publications on RG was observed, with a sharp rise following after its approval for clinical use. It was demonstrated recently that intensive training and supervision of patients with gout resulted in very low numbers of patients not reaching treatment targets. It should be remembered that allopurinol, is an ideal instrument for differentiating non-adherence from true impaired response. We conclude that, apart from very rare patients, needing confirmation of such a diagnosis by metabolic ward studies, RG does not exist, and with close to hundred percent, treatment failure is due to patient and physician behavior.
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11
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Major TJ, Dalbeth N, Stahl EA, Merriman TR. An update on the genetics of hyperuricaemia and gout. Nat Rev Rheumatol 2019; 14:341-353. [PMID: 29740155 DOI: 10.1038/s41584-018-0004-x] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A central aspect of the pathogenesis of gout is elevated urate concentrations, which lead to the formation of monosodium urate crystals. The clinical features of gout result from an individual's immune response to these deposited crystals. Genome-wide association studies (GWAS) have confirmed the importance of urate excretion in the control of serum urate levels and the risk of gout and have identified the kidneys, the gut and the liver as sites of urate regulation. The genetic contribution to the progression from hyperuricaemia to gout remains relatively poorly understood, although genes encoding proteins that are involved in the NLRP3 (NOD-, LRR- and pyrin domain-containing 3) inflammasome pathway play a part. Genome-wide and targeted sequencing is beginning to identify uncommon population-specific variants that are associated with urate levels and gout. Mendelian randomization studies using urate-associated genetic variants as unconfounded surrogates for lifelong urate exposure have not supported claims that urate is causal for metabolic conditions that are comorbidities of hyperuricaemia and gout. Genetic studies have also identified genetic variants that predict responsiveness to therapies (for example, urate-lowering drugs) for treatment of hyperuricaemia. Future research should focus on large GWAS (that include asymptomatic hyperuricaemic individuals) and on increasing the use of whole-genome sequencing data to identify uncommon genetic variants with increased penetrance that might provide opportunities for clinical translation.
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Affiliation(s)
- Tanya J Major
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Eli A Stahl
- Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand.
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The Role of a “Treat-to-Target” Approach in the Long-Term Renal Outcomes of Patients with Gout. J Clin Med 2019; 8:jcm8071067. [PMID: 31330801 PMCID: PMC6678146 DOI: 10.3390/jcm8071067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/10/2019] [Accepted: 07/17/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Although gout is accompanied by the substantial burden of kidney disease, there are limited data to assess renal function as a therapeutic target. This study evaluated the importance of implementing a “treat-to-target” approach in relation to renal outcomes. Methods: Patients with gout who underwent continuous urate-lowering therapy (ULT) for at least 12 months were included. The effect of ULT on renal function was investigated by means of a sequential comparison of the estimated glomerular filtration rate (eGFR). Results: Improvement in renal function was only demonstrated in subjects in whom the serum urate target of <6 mg/dL was achieved (76.40 ± 18.81 mL/min/1.73 m2 vs. 80.30 ± 20.41 mL/min/1.73 m2, p < 0.001). A significant difference in the mean change in eGFR with respect to serum urate target achievement was shown in individuals with chronic kidney disease stage 3 (−0.35 ± 3.87 mL/min/1.73 m2 vs. 5.33 ± 11.64 mL/min/1.73 m2, p = 0.019). Multivariable analysis predicted that patients ≥65 years old had a decreased likelihood of improvement (OR 0.31, 95% CI 0.13–0.75, p = 0.009). Conclusions: The “treat-to-target” approach in the long-term management of gout is associated with better renal outcomes, with a greater impact on those with impaired renal function.
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13
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Brackman DJ, Yee SW, Enogieru OJ, Shaffer C, Ranatunga D, Denny JC, Wei WQ, Kamatani Y, Kubo M, Roden DM, Jorgenson E, Giacomini KM. Genome-Wide Association and Functional Studies Reveal Novel Pharmacological Mechanisms for Allopurinol. Clin Pharmacol Ther 2019; 106:623-631. [PMID: 30924126 DOI: 10.1002/cpt.1439] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/22/2019] [Indexed: 12/19/2022]
Abstract
Allopurinol, which lowers uric acid (UA) concentration, is increasingly being recognized for its benefits in cardiovascular and renal disease. However, response to allopurinol is variable. We gathered samples from 4,446 multiethnic subjects for a genome-wide association study of allopurinol response. Consistent with previous studies, we observed that the Q141K variant in ABCG2 (rs2231142), which encodes the efflux pump breast cancer resistance protein (BCRP), associated with worse response to allopurinol. However, for the first time this association reached genome-wide level significance (P = 8.06 × 10-11 ). Additionally, we identified a novel association with a variant in GREM2 (rs1934341, P = 3.22 × 10-6 ). In vitro studies identified oxypurinol, the active metabolite of allopurinol, as an inhibitor of the UA transporter GLUT9, suggesting that oxypurinol may modulate UA reabsorption. These results provide strong evidence for a role of BCRP Q141K in allopurinol response, and suggest that allopurinol may have additional hypouricemic effects beyond xanthine oxidase inhibition.
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Affiliation(s)
- Deanna J Brackman
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - Sook Wah Yee
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - Osatohanmwen J Enogieru
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - Christian Shaffer
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dilrini Ranatunga
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wei-Qi Wei
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Michiaki Kubo
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Dan M Roden
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric Jorgenson
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Kathleen M Giacomini
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA.,Institute of Human Genetics, University of California San Francisco, San Francisco, California, USA
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Golenbiewski J, Keenan RT. Moving the Needle: Improving the Care of the Gout Patient. Rheumatol Ther 2019; 6:179-193. [PMID: 30826988 PMCID: PMC6514038 DOI: 10.1007/s40744-019-0147-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Indexed: 12/20/2022] Open
Abstract
Gout is a the most common inflammatory arthritis in the United States. It is a significant cause of morbidity, disability, lost work days, and high healthcare utilization due to intermittent attacks, chronic inflammation, and joint damage. Despite our understanding of the prelude and pathophysiology of gout, hyperuricemia, it is still poorly misunderstood by patients and poorly managed by healthcare providers. Several parallel treatment paradigms have been developed by professional societies around the world based on the understanding of how hyperuricemia occurs, gout epidemiology, expert opinion, and clinical trials data in order to lower uric acid and eventually eliminate the patient's crystal burden. This review focuses on both the treatment of acute attacks, and more importantly, the long-term management of gout and the lowering of serum uric acid levels to a goal of < 6 mg/dl (0.360 mmol/l) or treating to target. Treating to a target serum uric acid goal is an opportunity to decrease morbidity and improve the quality of care of every gout patient.
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Affiliation(s)
- Jon Golenbiewski
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Robert T Keenan
- Duke Gout and Crystal Arthropathies Clinic, Durham, NC, USA. .,Duke Specialty Infusion Centers, Durham, NC, USA. .,Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
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15
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Adherence and Outcomes with Urate-Lowering Therapy: A Site-Randomized Trial. Am J Med 2019; 132:354-361. [PMID: 30503879 PMCID: PMC6399023 DOI: 10.1016/j.amjmed.2018.11.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this study was to test a pharmacist-led intervention to improve gout treatment adherence and outcomes. METHODS We conducted a site-randomized trial (n=1463 patients) comparing a 1-year, pharmacist-led intervention to usual care in patients with gout initiating allopurinol. The intervention was delivered primarily through automated telephone technology. Co-primary outcomes were the proportion of patients adherent (proportion of days covered ≥0.8) and achieving a serum urate <6.0 mg/dl at 1 year. Outcomes were reassessed at year 2. RESULTS Patients who underwent intervention were more likely than patients of usual care to be adherent (50% vs 37%; odds ratio [OR] 1.68; 95% confidence interval [CI] 1.30, 2.17) and reach serum urate goal (30% vs 15%; OR 2.37; 95% CI 1.83, 3.05). In the second year (1 year after the intervention ended), differences were attenuated, remaining significant for urate goal but not for adherence. The intervention was associated with a 6%-16% lower gout flare rate during year 2, but the differences did not reach statistical significance. CONCLUSIONS A pharmacist-led intervention incorporating automated telephone technology improved adherence and serum urate goal in patients with gout initiating allopurinol. Although this light-touch, low-tech intervention was efficacious, additional efforts are needed to enhance patient engagement in gout management and ultimately to improve outcomes.
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16
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Hill-McManus D, Marshall S, Soto E, Lane S, Hughes D. Impact of Non-Adherence and Flare Resolution on the Cost-Effectiveness of Treatments for Gout: Application of a Linked Pharmacometric/Pharmacoeconomic Model. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:1373-1381. [PMID: 30502780 DOI: 10.1016/j.jval.2018.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/02/2018] [Accepted: 06/04/2018] [Indexed: 05/24/2023]
Abstract
BACKGROUND Dual urate-lowering therapy (ULT) with lesinurad in combination with either allopurinol or febuxostat is an option for patients with gout unsuccessfully treated on either monotherapy. Treatment failure is often a result of poor medication adherence. Imperfect adherence in clinical trials may lead to biased estimates of treatment effect and confound the results of cost-effectiveness analyses. OBJECTIVES To estimate the impact of varying medication adherence on the cost effectiveness of lesinurad dual therapy and estimate the value-based price of lesinurad at which the incremental cost-effectiveness ratio is equal to £20,000 per quality-adjusted life-year (QALY). METHODS Treatment effect was simulated using published pharmacokinetic-pharmacodynamic models and scenarios representing adherence in clinical trials, routine practice, and perfect use. The subsequent cost and health impacts, over the lifetime of a patient cohort, were estimated using a bespoke pharmacoeconomic model. RESULTS The base-case incremental cost-effectiveness ratios comparing lesinurad dual ULT with monotherapy ranged from £39,184 to £78,350/QALY gained using allopurinol and £31,901 to £124,212/QALY gained using febuxostat, depending on the assumed medication adherence. Results assuming perfect medication adherence imply a per-quarter value-based price of lesinurad of £45.14 when used in dual ULT compared with allopurinol alone and £57.75 compared with febuxostat alone, falling to £25.41 and £3.49, respectively, in simulations of worsening medication adherence. CONCLUSIONS The estimated value-based prices of lesinurad only exceeded that which has been proposed in the United Kingdom when assuming both perfect drug adherence and the eradication of gout flares in sustained treatment responders.
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Affiliation(s)
- Daniel Hill-McManus
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | | | - Elena Soto
- Pharmacometrics, Pfizer Ltd., Sandwich, UK
| | - Steven Lane
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK.
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17
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Chinese Multidisciplinary Expert Consensus on the Diagnosis and Treatment of Hyperuricemia and Related Diseases. Chin Med J (Engl) 2018; 130:2473-2488. [PMID: 29052570 PMCID: PMC5684625 DOI: 10.4103/0366-6999.216416] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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18
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Latourte A, Bardin T, Clerson P, Ea HK, Flipo RM, Richette P. Dyslipidemia, Alcohol Consumption, and Obesity as Main Factors Associated With Poor Control of Urate Levels in Patients Receiving Urate-Lowering Therapy. Arthritis Care Res (Hoboken) 2018; 70:918-924. [DOI: 10.1002/acr.23347] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 08/15/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Augustin Latourte
- Fédération de Rhumatologie; Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris; Université Paris 7; UFR médicale; and INSERM UMR1132; Hôpital Lariboisière Paris France
| | - Thomas Bardin
- Fédération de Rhumatologie; Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris; Université Paris 7; UFR médicale; and INSERM UMR1132; Hôpital Lariboisière Paris France
| | | | - Hang-Korng Ea
- Fédération de Rhumatologie; Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris; Université Paris 7; UFR médicale; and INSERM UMR1132; Hôpital Lariboisière Paris France
| | - René-Marc Flipo
- Hôpital Roger-Salengro; CHRU de Lille; and Université de Lille 2; Lille France
| | - Pascal Richette
- Fédération de Rhumatologie; Hôpital Lariboisière; Assistance Publique-Hôpitaux de Paris; Université Paris 7; UFR médicale; and INSERM UMR1132; Hôpital Lariboisière Paris France
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19
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Ranieri L, Contero C, Peral ML, Calabuig I, Zapater P, Andres M. Impact of diuretics on the urate lowering therapy in patients with gout: analysis of an inception cohort. Arthritis Res Ther 2018; 20:53. [PMID: 29566736 PMCID: PMC5863897 DOI: 10.1186/s13075-018-1559-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 03/06/2018] [Indexed: 11/26/2022] Open
Abstract
Background Diuretics have been associated with impaired response and refractoriness in gout, but whether this effect is still present with new urate-lowering drugs (ULD) and treat-to-target strategies is unknown. The aim of the present study was to assess the impact of the diuretics on the response to ULD in patients with gout. Methods This was a retrospective analysis of an inception cohort. Participants were classified according to the type of ULD prescribed. We analysed the maximal dose of ULD (primary outcome variable), serum urate (SU) reduction, and the achievement of different SU targets (6 mg/dL, 5 mg/dL, and 4 mg/dL), according to the type of ULD prescribed and use of diuretics (loop and/or thiazide). We adjusted for confounders using multiple linear regression analysis. Results We included 245 patients: 208 treated with allopurinol (66 on diuretics, 31.7%), 35 with febuxostat (19 on diuretics, 57.6%), and 2 with benzbromarone. Significantly fewer participants in the allopurinol plus diuretics subgroup achieved SU levels of less than 5 mg/dL, but we found no other significant differences in SU targets associated with diuretics. Regarding the maximum ULD dose, a simple linear regression suggested an inverse relationship with diuretics (beta = − 0.125, p = 0.073), but this did not hold in the multivariable analysis (beta = − 0.47, p = 0.833). There was no association with febuxostat (beta = − 0.116, p = 0.514). Conclusion Diuretics do not appear to have a significant impact on managing gout. Electronic supplementary material The online version of this article (10.1186/s13075-018-1559-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura Ranieri
- Rheumatology Deparment, Hospital General Universitario de Alicante-ISABIAL, Pintor Baeza 12, 03010, Alicante, Spain
| | | | - Maria-Luisa Peral
- Rheumatology Deparment, Hospital General Universitario de Alicante-ISABIAL, Pintor Baeza 12, 03010, Alicante, Spain
| | - Irene Calabuig
- Rheumatology Deparment, Hospital General Universitario de Alicante-ISABIAL, Pintor Baeza 12, 03010, Alicante, Spain
| | - Pedro Zapater
- Universidad Miguel Hernández, Elche, Alicante, Spain.,Clinical Pharmacology Deparment, Hospital General Universitario de Alicante-ISABIAL, Alicante, Spain
| | - Mariano Andres
- Rheumatology Deparment, Hospital General Universitario de Alicante-ISABIAL, Pintor Baeza 12, 03010, Alicante, Spain. .,Universidad Miguel Hernández, Elche, Alicante, Spain.
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20
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Hill‐McManus D, Soto E, Marshall S, Lane S, Hughes D. Impact of non-adherence on the safety and efficacy of uric acid-lowering therapies in the treatment of gout. Br J Clin Pharmacol 2018; 84:142-152. [PMID: 28888218 PMCID: PMC5736842 DOI: 10.1111/bcp.13427] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/17/2017] [Accepted: 09/05/2017] [Indexed: 01/09/2023] Open
Abstract
AIMS Dual-urate-lowering therapy (ULT) with xanthine oxidase inhibitor and uricosuric medications is a treatment option for severe gout. Uricosuric agents can cause hyperuricosuria, a risk factor for nephrolithiasis and acute uric acid nephropathy. The aims of the present study were to simulate the relationship between suboptimal drug adherence and efficacy, and to quantify the risk of hyperuricosuria in gout patients receiving mono- and dual-ULTs. METHODS The impact of poor medication adherence was studied using two-compartment pharmacokinetic (PK) models based on published evidence, and a semi-mechanistic four-compartment pharmacodynamic (PD) model. The PKPD model was used to simulate mono and dual-ULT in gout patients with either under-excretion (lowered clearance) or overproduction of uric acid, with suboptimal adherence modelled as either a single drug holiday of increasing duration or doses taken at random. RESULTS Simulation results showed a surge in urinary uric acid occurring when dosing is restarted following missed doses. For under-excreters taking a 20-day drug holiday, the addition of 200 mg (or 400 mg) lesinurad to 80 mg febuxostat increased the percentage of patients experiencing hyperuricosuria from 0% to 1.4% (or 3.1%). In overproducers, restarting ULTs following drug holidays of more than 5 days leads to over 60% of patients experiencing hyperuricosuria. CONCLUSIONS Suboptimal medication adherence may compromise the safety and efficacy of mono- and dual-ULTs, especially in patients with gout resulting from an overproduction of uric acid. Clinicians and pharmacists should consider counselling patients with respect to the risks associated with partial adherence, and offer interventions to improve adherence or tailor treatments, where appropriate.
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Affiliation(s)
- Daniel Hill‐McManus
- Centre for Health Economic and Medicines EvaluationBangor UniversityBangorUK
| | | | | | - Steven Lane
- Department of BiostatisticsUniversity of LiverpoolLiverpoolUK
| | - Dyfrig Hughes
- Centre for Health Economic and Medicines EvaluationBangor UniversityBangorUK
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21
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Day RO, Frensham LJ, Nguyen AD, Baysari MT, Aung E, Lau AYS, Zwar N, Reath J, Laba T, Li L, McLachlan A, Runciman WB, Buchbinder R, Clay-Williams R, Coiera E, Braithwaite J, McNeil HP, Hunter DJ, Pile KD, Portek I, WIlliams KM, Westbrook JI. Effectiveness of an electronic patient-centred self-management tool for gout sufferers: a cluster randomised controlled trial protocol. BMJ Open 2017; 7:e017281. [PMID: 29042386 PMCID: PMC5652564 DOI: 10.1136/bmjopen-2017-017281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Gout is increasing despite effective therapies to lower serum urate concentrations to 0.36 mmol/L or less, which, if sustained, significantly reduces acute attacks of gout. Adherence to urate-lowering therapy (ULT) is poor, with rates of less than 50% 1 year after initiation of ULT. Attempts to increase adherence in gout patients have been disappointing. We aim to evaluate the effectiveness of use of a personal, self-management, 'smartphone' application (app) to achieve target serum urate concentrations in people with gout. We hypothesise that personalised feedback of serum urate concentrations will improve adherence to ULT. METHODS AND ANALYSIS Setting and designPrimary care. A prospective, cluster randomised (by general practitioner (GP) practices), controlled trial. PARTICIPANTS GP practices will be randomised to either intervention or control clusters with their patients allocated to the same cluster. INTERVENTION The intervention group will have access to the Healthy.me app tailored for the self-management of gout. The control group patients will have access to the same app modified to remove all functions except the Gout Attack Diary. PRIMARY AND SECONDARY OUTCOMES The proportion of patients whose serum urate concentrations are less than or equal to 0.36 mmol/L after 6 months. Secondary outcomes will be proportions of patients achieving target urate concentrations at 12 months, ULT adherence rates, serum urate concentrations at 6 and 12 months, rates of attacks of gout, quality of life estimations and process and economic evaluations. The study is designed to detect a ≥30% improvement in the intervention group above the expected 50% achievement of target serum urate at 6 months in the control group: power 0.80, significance level 0.05, assumed 'dropout' rate 20%. ETHICS AND DISSEMINATION This study has been approved by the University of New South Wales Human Research Ethics Committee. Study findings will be disseminated in international conferences and peer-reviewed journal. TRIAL REGISTRATION NUMBER ACTRN12616000455460.
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Affiliation(s)
- Richard O Day
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School, St Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Lauren J Frensham
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School, St Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Amy D Nguyen
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School, St Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Melissa T Baysari
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Eindra Aung
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School, St Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Annie Y S Lau
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Nicholas Zwar
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Jennifer Reath
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Tracey Laba
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia
- The Menzies Centre for Health Policy, Sydney Medical School, The University of Sydney, Sydney, Australia
- The Centre for Clinical Epidemiology and Evaluation, The University of British Columbia, Vancouver, Canada
| | - Ling Li
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Andrew McLachlan
- Faculty of Pharmacy and Centre for Education and Research on Ageing, University of Sydney, Sydney, Australia
| | - William B Runciman
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robyn Clay-Williams
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Enrico Coiera
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - H Patrick McNeil
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - David J Hunter
- Institute of Bone and Joint Research, Kolling Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
- Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
| | - Kevin D Pile
- Department of Medicine, Western Sydney University, Sydney, Australia
- Department of Rheumatology, Campbelltown Hospital, Sydney, Australia
| | - Ian Portek
- St George and Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Department of Rheumatology, St George Hospital, Sydney, Australia
| | - Kenneth Mapson WIlliams
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School, St Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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22
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Guttmann A, Krasnokutsky S, Pillinger MH, Berhanu A. Pegloticase in gout treatment - safety issues, latest evidence and clinical considerations. Ther Adv Drug Saf 2017; 8:379-388. [PMID: 29204266 DOI: 10.1177/2042098617727714] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/26/2017] [Indexed: 01/03/2023] Open
Abstract
Gout is a common rheumatic condition, with increasing prevalence in recent decades. The mainstay of treatment for gout is oral urate-lowering therapy (ULT), typically with xanthine oxidase inhibitors (XOIs). Unfortunately, a proportion of patients have persistent gout that is refractory to ULT. Pegloticase, a recombinant pegylated uricase, has been approved by the US Food and Drug Administration for the treatment of refractory gout. However, concern has been raised regarding the risk of infusion reactions, which are now understood to be largely due to the development of antipegloticase antibodies. Discontinuation of pegloticase upon failure to lower serum urate has been shown to markedly reduce infusion reaction risk, but deprives patients of what, in many cases, is a last-resort treatment. In this manuscript, we review the rationale, mechanism of action, efficacy and safety of pegloticase. Additionally, we focus on potential strategies to reduce pegloticase immunogenicity and potentially make this important agent available to a wider group of patients requiring treatment.
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Affiliation(s)
- Allison Guttmann
- Crystal Disease Study Group, Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Svetlana Krasnokutsky
- Crystal Disease Study Group, Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Michael H Pillinger
- Crystal Disease Study Group, Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Adey Berhanu
- Division of Rheumatology, George Washington University School of Medicine, Medical Faculty Associates, Suite 307, 2300 M Street Northwest, Washington, DC 20037, USA
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Bardin T, Richette P. Impact of comorbidities on gout and hyperuricaemia: an update on prevalence and treatment options. BMC Med 2017; 15:123. [PMID: 28669352 PMCID: PMC5494879 DOI: 10.1186/s12916-017-0890-9] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 06/12/2017] [Indexed: 02/07/2023] Open
Abstract
Gout, the most prevalent inflammatory arthritis worldwide, is associated with cardiovascular and renal diseases, and is an independent predictor of premature death. The frequencies of obesity, chronic kidney disease (CKD), hypertension, type 2 diabetes, dyslipidaemias, cardiac diseases (including coronary heart disease, heart failure and atrial fibrillation), stroke and peripheral arterial disease have been repeatedly shown to be increased in gout. Therefore, the screening and care of these comorbidities as well as of cardiovascular risk factors are of outmost importance in patients with gout. Comorbidities, especially CKD, and drugs prescribed for their treatment, also impact gout management. Numerous epidemiological studies have shown the association of asymptomatic hyperuricaemia with the above-mentioned diseases and cardiovascular risk factors. Animal studies have also produced a mechanistic approach to the vascular toxicity of soluble urate. However, causality remains uncertain because confounders, reverse causality or common etiological factors might explain the epidemiological results. Additionally, these uncertainties remain unsolved despite recent studies using Mendelian randomisation or therapeutic approaches. Thus, large randomised placebo-controlled trials are still needed to assess the benefits of treating asymptomatic hyperuricaemia.
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Affiliation(s)
- Thomas Bardin
- Université Paris Diderot, UFR médicale, Paris, France. .,Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Service de Rhumatologie, Paris, Cedex, France. .,INSERM 1132, Université Paris-Diderot, Hôpital Lariboisière, Paris, France. .,French-Vietnamese Research Center on Gout, Ho Chi Minh City, Vietnam.
| | - Pascal Richette
- Université Paris Diderot, UFR médicale, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Service de Rhumatologie, Paris, Cedex, France.,INSERM 1132, Université Paris-Diderot, Hôpital Lariboisière, Paris, France
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24
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Cleophas MC, Joosten LA, Stamp LK, Dalbeth N, Woodward OM, Merriman TR. ABCG2 polymorphisms in gout: insights into disease susceptibility and treatment approaches. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2017; 10:129-142. [PMID: 28461764 PMCID: PMC5404803 DOI: 10.2147/pgpm.s105854] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
As a result of the association of a common polymorphism (rs2231142, Q141K) in the ATP-binding cassette G2 (ABCG2) transporter with serum urate concentration in a genome-wide association study, it was revealed that ABCG2 is an important uric acid transporter. This review discusses the relevance of ABCG2 polymorphisms in gout, possible etiological mechanisms, and treatment approaches. The 141K ABCG2 urate-increasing variant causes instability in the nucleotide-binding domain, leading to decreased surface expression and function. Trafficking of the protein to the cell membrane is altered, and instead, there is an increased ubiquitin-mediated proteasomal degradation of the variant protein as well as sequestration into aggresomes. In humans, this leads to decreased uric acid excretion through both the kidney and the gut with the potential for a subsequent compensatory increase in renal urinary excretion. Not only does the 141K polymorphism in ABCG2 lead to hyperuricemia through renal overload and renal underexcretion, but emerging evidence indicates that it also increases the risk of acute gout in the presence of hyperuricemia, early onset of gout, tophi formation, and a poor response to allopurinol. In addition, there is some evidence that ABCG2 dysfunction may promote renal dysfunction in chronic kidney disease patients, increase systemic inflammatory responses, and decrease cellular autophagic responses to stress. These results suggest multiple benefits in restoring ABCG2 function. It has been shown that decreased ABCG2 141K surface expression and function can be restored with colchicine and other small molecule correctors. However, caution should be exercised in any application of these approaches given the role of surface ABCG2 in drug resistance.
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Affiliation(s)
- M C Cleophas
- Department of Internal Medicine.,Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - L A Joosten
- Department of Internal Medicine.,Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Medical Genetics, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - L K Stamp
- Department of Medicine, University of Otago Christchurch, Christchurch
| | - N Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - O M Woodward
- Department of Physiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
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25
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Stamp LK, Merriman T, Frampton C, Zhang M, Wallace M, Miner JN, Dalbeth N. Plasma oxypurinol as a measure of adherence in clinical trials. Ann Rheum Dis 2017; 77:313-314. [DOI: 10.1136/annrheumdis-2016-210661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/15/2016] [Accepted: 12/17/2016] [Indexed: 11/04/2022]
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26
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Day RO, Kannangara DR, Stocker SL, Carland JE, Williams KM, Graham GG. Allopurinol: insights from studies of dose–response relationships. Expert Opin Drug Metab Toxicol 2016; 13:449-462. [DOI: 10.1080/17425255.2017.1269745] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Richard O. Day
- Department of Clinical Pharmacology & Toxicology, St Vincent’s Hospital, Darlinghurst, Sydney, Australia
- St Vincent’s Clinical School, UNSW Australia, Darlinghurst, Sydney, Australia
| | - Diluk R.W. Kannangara
- Department of Clinical Pharmacology & Toxicology, St Vincent’s Hospital, Darlinghurst, Sydney, Australia
- St Vincent’s Clinical School, UNSW Australia, Darlinghurst, Sydney, Australia
| | - Sophie L. Stocker
- Department of Clinical Pharmacology & Toxicology, St Vincent’s Hospital, Darlinghurst, Sydney, Australia
- School of Medical Sciences, UNSW Australia, Kensington, Sydney, Australia
| | - Jane E. Carland
- Department of Clinical Pharmacology & Toxicology, St Vincent’s Hospital, Darlinghurst, Sydney, Australia
- School of Medical Sciences, UNSW Australia, Kensington, Sydney, Australia
| | - Kenneth M. Williams
- Department of Clinical Pharmacology & Toxicology, St Vincent’s Hospital, Darlinghurst, Sydney, Australia
- School of Medical Sciences, UNSW Australia, Kensington, Sydney, Australia
| | - Garry G. Graham
- Department of Clinical Pharmacology & Toxicology, St Vincent’s Hospital, Darlinghurst, Sydney, Australia
- School of Medical Sciences, UNSW Australia, Kensington, Sydney, Australia
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27
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Carroll MB, Smith DM, Shaak TL. Genomic sequencing of uric acid metabolizing and clearing genes in relationship to xanthine oxidase inhibitor dose. Rheumatol Int 2016; 37:445-453. [PMID: 27798726 DOI: 10.1007/s00296-016-3592-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/22/2016] [Indexed: 12/01/2022]
Abstract
It remains unclear why the dose of xanthine oxidase inhibitors (XOI) allopurinol or febuxostat varies among patients though they reach similar serum uric acid (SUA) goal. We pursued genomic sequencing of XOI metabolism and clearance genes to identify single-nucleotide polymorphisms (SNPs) relate to differences in XOI dose. Subjects with a diagnosis of Gout based on the 1977 American College of Rheumatology Classification Criteria for the disorder, who were on stable doses of a XOI, and who were at their goal SUA level, were enrolled. The primary outcome was relationship between SNPs in any of these genes to XOI dose. The secondary outcome was relationship between SNPs and change in pre- and post-treatment SUA. We enrolled 100 subjects. The average patient age was 68.6 ± 10.6 years old. Over 80% were men and 77% were Caucasian. One SNP was associated with a higher XOI dose: rs75995567 (p = 0.031). Two SNPs were associated with 300 mg daily of allopurinol: rs11678615 (p = 0.022) and rs3731722 on Aldehyde Oxidase (AO) (His1297Arg) (p = 0.001). Two SNPs were associated with a lower dose of allopurinol: rs1884725 (p = 0.033) and rs34650714 (p = 0.006). For the secondary outcome, rs13415401 was the only SNP related to a smaller mean SUA change. Ten SNPs were identified with a larger change in SUA. Though multiple SNPs were identified in the primary and secondary outcomes of this study, rs3731722 is known to alter catalytic function for some aldehyde oxidase substrates.
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Affiliation(s)
| | - Derek M Smith
- Lackland AFB, 2200 Bergquist Drive, Ste 1, San Antonio, TX, 78236, USA
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28
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Pilot study of a multidisciplinary gout patient education and monitoring program. Semin Arthritis Rheum 2016; 46:601-608. [PMID: 27931979 DOI: 10.1016/j.semarthrit.2016.10.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/17/2016] [Accepted: 10/19/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Gout patient self-management knowledge and adherence to treatment regimens are poor. Our objective was to assess the feasibility and acceptability of a multidisciplinary team-based pilot program for the education and monitoring of gout patients. METHODS Subjects completed a gout self-management knowledge exam, along with gout flare history and compliance questionnaires, at enrollment and at 6 and 12 months. Each exam was followed by a nursing educational intervention via a structured gout curriculum. Structured monthly follow-up calls from pharmacists emphasized adherence to management programs. Primary outcomes were subject and provider program evaluation questionnaires at 6 and 12 months, program retention rate and success in reaching patients via monthly calls. RESULTS Overall, 40/45 subjects remained in the study at 12 months. At 12 months, on a scale of 1 (most) to 5 (least), ratings of 3 or better were given by 84.6% of subjects evaluating the usefulness of the overall program in understanding and managing their gout, 81.0% of subjects evaluating the helpfulness of the nursing education program, and 50.0% of subjects evaluating the helpfulness of the calls from the pharmacists. Knowledge exam questions that were most frequently answered incorrectly on repeat testing concerned bridge therapy, the possibility of being flare-free, and the genetic component of gout. CONCLUSIONS Our multidisciplinary program of gout patient education and monitoring demonstrates feasibility and acceptability. We identified variability in patient preference for components of the program and persistent patient knowledge gaps.
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Sattui SE, Gaffo AL. Treatment of hyperuricemia in gout: current therapeutic options, latest developments and clinical implications. Ther Adv Musculoskelet Dis 2016; 8:145-59. [PMID: 27493693 PMCID: PMC4959626 DOI: 10.1177/1759720x16646703] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite being the most common type of inflammatory arthritis, gout is often poorly managed. Except for febuxostat and pegloticase, research in new therapeutic agents for the management of hyperuricemia in gout remained insufficient for several decades. With emerging evidence of possible roles of hyperuricemia in cardiometabolic comorbidities, as well as more convincing evidence regarding poor outcomes (e.g. disability, recurrent hospital admissions) in patients with uncontrolled gout, several agents are current under development. Increasing knowledge regarding renal urate transporters has resulted in the development of new generation uricosurics such as lesinurad and arhalofenate. This review aims at discussing current therapeutic strategies for gout, as well as their limitations and the possible role of emerging agents in the chronic management of hyperuricemia in gout. Drugs in phases I and II of development will be discussed, along with new agents and therapeutic classes, such as purine nucleoside phosphorylase inhibitors and dual-action drugs. These new developments are encouraging, and will hopefully contribute to a more adequate management of hyperuricemia in gout.
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Affiliation(s)
- Sebastian E. Sattui
- Tinsley Harrison Internal Medicine Residency Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Angelo L. Gaffo
- University of Alabama, School of Medicine, Division of Clinical Immunology and Rheumatology, Department of Medicine, Shelby Building 201, 1825 University Boulevard, Birmingham, AL 35294, USA
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30
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31
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Shmerling RH. Editorial: The Ethics of Recent Gout Trials. Arthritis Rheumatol 2016; 68:2057-60. [DOI: 10.1002/art.39723] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/14/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Robert H. Shmerling
- Beth Israel Deaconess Medical Center, Boston, Massachusetts; Chair, American College of Rheumatology Committee on Ethics and Conflicts of Interest
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Knowledge, illness perceptions and stated clinical practice behaviour in management of gout: a mixed methods study in general practice. Clin Rheumatol 2016; 35:2053-2061. [PMID: 26898982 PMCID: PMC4960270 DOI: 10.1007/s10067-016-3212-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/03/2016] [Accepted: 02/06/2016] [Indexed: 01/31/2023]
Abstract
The objective of the present study is to explore knowledge, illness perceptions and stated practice behaviour in relation to gout in primary care. This is a mixed methods study among 32 general practitioners (GPs). The quantitative assessment included the Gout Knowledge Questionnaire (GKQ; range 0–10; better) and Brief Illness Perceptions Questionnaire (BIPQ; nine items, range 0–10; stronger). Structured individual interviews obtained further qualitative insight into knowledge and perceptions, in the context of daily practice. Among 32 GPs, 18 (56.3 %) were male, mean age 44.4 years (SD 9.6) and mean working experience 17.1 years (SD 9.7). Median score [interquartile ranges (IQR)] on the GKQ was 7.8 [6.7–8.9] and 9.0 [8.0–10.0], when presented as open or multiple-choice questions, respectively. The BIPQ (median; [IQR]) revealed that gout was seen as a chronic disease (8.0; [7.0–9.0]), affecting life and emotions moderately (6.5; [5.0–7.0]), having many severe symptoms (8.0; [7.0–9.0]) and in which treatment could be very helpful (8.0; [7.0–9.0]). Further interviews revealed large variation in specific aspects of knowledge and about gaps concerning indications for uric acid-lowering therapy (UALT), duration of UALT, target serum uric acid (sUA) level or duration of prophylactic treatment. Finally, patients’ adherence was not checked systematically. Specific knowledge gaps and discrepancies between perceptions and stated practice behaviour were identified, which might hamper effective management of this well-treatable disease. Improving evidence on the rationale and effectiveness of treatment targets and adherence interventions, tailoring guidelines to general practice and intensification of implementation of guidelines in primary health care seem to be needed.
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ABCG2 loss-of-function polymorphism predicts poor response to allopurinol in patients with gout. THE PHARMACOGENOMICS JOURNAL 2016; 17:201-203. [PMID: 26810134 DOI: 10.1038/tpj.2015.101] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/19/2015] [Accepted: 11/16/2015] [Indexed: 01/04/2023]
Abstract
Many patients fail to achieve the recommended serum urate (SU) target (<6 mgdl-1) with allopurinol. The aim of our study was to examine the association of ABCG2 with SU target in response to standard doses of allopurinol using a cohort with confirmed adherence. Good response was defined as SU<6 mgdl-1 on allopurinol ⩽300 mgd-1 and poor response as SU⩾6 mgdl-1 despite allopurinol >300 mgd-1. Adherence was confirmed by oxypurinol concentrations. ABCG2 genotyping was performed using pre-designed single nucleotide polymorphism (SNP) TaqMan assays. Of 264 patients, 120 were good responders, 68 were poor responders and 76 were either non-adherent or could not be classified. The minor allele of ABCG2 SNP rs2231142 conferred a significantly increased risk of poor response to allopurinol (odds ratio=2.71 (1.70-4.48), P=6.0 × 10-5). This association remained significant after adjustment for age, sex, body mass index, ethnicity, estimated glomerular filtration rate, diuretic use and SU off urate-lowering therapy. ABCG2 rs2231142 predicts poor response to allopurinol, as defined by SU⩾6 mgdl-1 despite allopurinol >300 mgd-1.
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35
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Day RO. Prednisone for cardiac failure in patients with hypertension. J Rheumatol 2015; 42:739-740. [PMID: 25934877 DOI: 10.3899/jrheum.150276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Richard O Day
- Clinical Pharmacology, St. Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia.
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36
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Roberts RL, Stamp LK. Pharmacogenetic considerations in the treatment of gout. Pharmacogenomics 2015; 16:619-29. [PMID: 25876828 DOI: 10.2217/pgs.15.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Gout is one of the most common forms of arthritis and the prevalence is increasing. Management comprises rapid and effective control of the inflammation in acute gout and sustained urate lowering in the long term. Improving the outcomes for cheaper old drugs and for the increasing number of new, more expensive agents is an important clinical goal. The role of pharmacogenetics in predicting response and adverse events to gout therapies is of considerable interest. Currently, prospective screening is employed to detect HLA-B*5801 carriage and glucose-6-phosphate dehydrogenase deficiency, to minimize occurrence of allopurinol hypersensitivity and pegloticase-related hemolytic anemia. In the future it is likely that other genetic markers of drug response will make the transition to clinical practice to further improve the efficacy and safety of gout therapies. In this review, we will examine the potential clinical relevance of specific genetic variants in the management of gout.
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Affiliation(s)
- Rebecca L Roberts
- Department of Surgical Sciences, Dunedin School of Medicine, Dunedin, New Zealand
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37
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Robinson PC, Dalbeth N. Advances in pharmacotherapy for the treatment of gout. Expert Opin Pharmacother 2014; 16:533-46. [DOI: 10.1517/14656566.2015.997213] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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