SAT0433\u2005AN ANALYSIS OF PRESCRIPTION RECORDS OF GOUT PATIENTS IN EUROPE: EVIDENCE OF SUBOPTIMAL MANAGEMENT AND CLINICAL INERTIA

Abstract

Background Urate-lowering therapy (ULT) should be prescribed to people with recurrent gout flares and tophi, and offered to people with first-onset gout. Despite effective drugs, gout flares are common. Reasons for this include lack of prescription of ULT, under-dosing of ULT by physicians (clinical inertia), and poor adherence to ULT. Objectives To ascertain the quality of gout care delivered by general practitioners (GPs), prescribing patterns for ULT were analysed in 4 western European countries. Methods Data for this retrospective study were obtained from IQVIA’s Real-World Data Longitudinal Prescription databases of GPs from France, Italy, Spain and United Kingdom (UK). The databases contain anonymised patient prescription records, including demographics, dispensing details (pharmacy, prescription date), and medication (name, dose, therapy duration). Data for patients with gout with or w/o ULT were analysed from July 2015 to June 2016. Results Crude prevalence of gout was 0.7% (UK) to 1.1% (France, Italy, and Spain) [Table 1]. Only about half (France, Italy, UK) to 2/3 (Spain) of diagnosed patients were on ULT. Between 19.9% (France) and 56.4% (Spain) of people on ULT had serum urate (sUA) measurements recorded within the year. Only 26.6% (Italy) to 45.6% (France) of patients with a recorded sUA level were at target (<6.0 mg/dL). The most common 1st-line treatment was allopurinol (ALLO), almost always at a dose ≤300 mg/d. Febuxostat (FBX) was prescribed as a 1st-line alternative in France and Italy. Switch to 2nd-line ULT, such as FBX, was uncommon, especially in Spain and UK. Uricosurics in monotherapy were not used. Average time on ULT ranged from 57.3% (Italy) to 72.6% (France) of the assessment year. At least one comorbidity (CM) was present in >78% of patients, the most common being hypertension, dyslipidemia, diabetes, chronic kidney disease, and obesity. Conclusion In the study period, management of patients with gout in 4 EU countries was suboptimal. Nearly half of diagnosed patients were not prescribed ULT. sUA levels were not being monitored regularly and mean sUA levels were above target. ALLO as the most common 1st-line ULT was generally prescribed at sub-therapeutic doses. Initiation of 2nd-line therapy was infrequent indicating a status quo and/or other reasons and medication adherence was poor indicating low patient self-management and/or low monitoring by GPs. Early treatment was not being initiated despite a high prevalence of CMs. Efforts must be undertaken to improve gout management, avoid clinical inertia, and reduce the individual and societal burden of gout. Table 1. Prescribing information for patients with a diagnosis of gout who were receiving anti-gout treatment (M04A chronic therapy; *based upon 2016 statistics). France Italy Spain UK Total diagnosed patients, n 736,352 642,063 523,592 441,505 Crude prevalence* (%) 1.1 1.1 1.1 0.7 Treated patients, n (%) 397,689 (54.0) 311,688 (48.5) 365,030 (69.7) 244,899 (55.5) sUA measurement recorded in the year (%) 19.9 56.4 39.5 40.3 Mean sUA, mg/dL 6.5 8.1 6.7 6.5 Achieved sUA goal (among patients with sUA measurement recorded in the year) (%) <6.0 mg/dL 45.6 26.6 37.9 41.9 ≥6.0 − <9.0 mg/dL 44.4 47.8 47.2 50.3 ≥9.0 mg/dL 9.9 25.6 14.8 7.7 Treatment (%) Allopurinol <300mg 300mg >300mg 57.415.70.5 6.543.90.1 23.415.30.1 23.013.22.8 Febuxostat 28.2 14.2 1.0 2.0 Second-line treatment (%) 15.9 13.4 1.9 4.3 Average days on treatment, n 265 209 218 247 Comorbidities present (%) 86.1 93.6 96.8 78.8 Disclosure of Interests Frederic Lioté Grant/research support from: institutional grants from Grunenthal, Ipsen Pharma/Menarini, Novartis, SOBI for the European Crystal Network Workshops, Consultant for: Grunenthal, Novartis, Ravi Karra Employee of: Grunenthal, Prashanth Kandaswamy Employee of: Grunenthal, Abhishek Abhishek Grant/research support from: AstraZeneca and OxfordImmunotech, Grant/research support from: AstraZeneca and Oxford Immunotech, Speakers bureau: Menarini pharmaceuticals, Speakers bureau: Menarini pharmaceuticals, Carlo Alberto Scirè: None declared, Fernando Perez-Ruiz Grant/research support from: Cruces Rheumatology Association, Consultant for: Grunenthal, Menarini, Horizon, Speakers bureau: Menarini, Grunenthal; Spanish foundation for rheumatology