The prescription of allopurinol in a tertiary care centre: appropriate indications and dose adjustment

Efficacy and Outcomes of a Novel Telephone-based Gout Disease Management Program

Objective:

Gout is the most common inflammatory arthritis in the United States. Despite published guidelines, management remains suboptimal, leading to unnecessary morbidity and increased cost of care. We have designed the gout disease management program (GDMP) to improve outcomes, increase patient satisfaction, and decrease healthcare utilization.

Methods:

Gout patients were seen at their usual rheumatology clinical visit and offered participation in the GDMP. Data were collected between April 2017 and November 2019. Serum uric acid (SUA) levels were measured at the initial outpatient encounter, at the entrance to GDMP, and every 4 weeks until SUA was at the goal of ≤6 mg/dl. Through telephonic encounters, gout-related recent hospitalizations, and ER or urgent care visits since the last encounter were ascertained. Self-reported gout medication usage and adherence were also determined. Patient satisfaction with GDMP was surveyed using a 5-point Likert scale.

Results:

A total of 158 patients were enrolled, of which 112 had ≥ 1 telephone encounter and were included in our analyses. During the telephone phase, 79 patients (70%) achieved the SUA goal of ≤6.0 mg/dl. Only 3 patients (2.6%) required hospitalization or visits to an ER or urgent care center due to gout flare, and 98% rated their encounter as a 5 on the 5-point Likert scale.

Conclusion:

Our telephone-based management program for gout led to improved clinical outcomes as defined by the ACR guidelines, decreased healthcare visits, and had high patient satisfaction.

Significance and Innovations:

• First telephone-based, rheumatology providers-led study to manage gout

• Additional evidence to confirm the feasibility and benefit of telemedicine in common diseases

• First study to show excellent patient satisfaction

The pattern of allopurinol prescription in a university hospital practice

Background

Allopurinol as a drug is commonly used to treat gout and its complications. The aim usually is to lower the level of serum uric acid. Also, it was found to be prescribed in cases of asymptomatic hyperuricemia. However, this medication has serious side effects and some of these are fatal. So the aim of the current research work is to look at its use, whether properly indicated or not, in a university hospital.

Results

A total of 427 patients were included in this study. Only 3.7% (16) of the patients had the drug for significant hyperuricemia. Gout was confirmed in 40 (9.4%) patients.

Conclusion

It is clear that most patients received allopurinol without proper indications. The inappropriate use of allopurinol should be looked at to reduce the cost of medication and more importantly to avoid possible adverse effects.

Allopurinol prescription patterns among patients in a Saudi tertiary care centre

Objective

Physicians frequently prescribe allopurinol for uric acid deposition disorders. However, reports have emerged of the inappropriate use and overprescription of allopurinol. We conducted this study to determine the rate of inappropriate prescription of allopurinol in a Saudi institution.

Methods

This cross-sectional descriptive study was conducted on all adult patients who had been prescribed allopurinol in Doctor Soliman Fakeeh Hospital Jeddah KSA. Demographic data and laboratory results were retrieved from patients’ electronic health records (EHR). We considered valid indications of allopurinol as significant hyperuricemia (>13 mg/dL in men and >10 mg/dL in women), confirmed gout, hyperuricosuria of more than 1100 mg/day, uric acid stones or recurrent calcium oxalate kidney stones, malignancy, and haemolysis. The possible valid indications were unconfirmed gout and unconfirmed type of kidney stones, whereas no documented indication or insignificant hyperuricemia was considered as an invalid indication.

Results

We included 1978 patients in this study. The cohort was composed of 76.4% men and 23.6% women. The mean ± standard deviation of age of this patient cohort was 53 and 4 months ± 15 years. The mean ± standard deviation of duration since the first prescription was 1.53 ± 2.2 years. Physicians prescribed allopurinol without a valid indication in 1539 patients (77.8%). More than a third of the patients (39%) did not have a documented indication and 38.8% were prescribed allopurinol for insignificant hyperuricemia.

Conclusion

This study revealed a markedly high number of allopurinol prescriptions without a clear indication in our centre. This approach may potentially expose patients to serious side effects of allopurinol without added benefits.