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Predictors of reaching a serum uric acid goal in patients with gout and treated with febuxostat
PURPOSE: Clinical guidelines recommend febuxostat as first-line pharmacologic urate-lowering therapy for patients with gout to achieve a goal serum uric acid (sUA) <6 mg/dL; however, little is known about other contributing factors. This study identified clinical characteristics of patients treat...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove Medical Press
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644566/ https://www.ncbi.nlm.nih.gov/pubmed/29066924 http://dx.doi.org/10.2147/CEOR.S139939 |
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author | Sheer, Richard Null, Kyle D Szymanski, Keith A Sudharshan, Lavanya Banovic, Jennifer Pasquale, Margaret K |
author_facet | Sheer, Richard Null, Kyle D Szymanski, Keith A Sudharshan, Lavanya Banovic, Jennifer Pasquale, Margaret K |
author_sort | Sheer, Richard |
collection | PubMed |
description | PURPOSE: Clinical guidelines recommend febuxostat as first-line pharmacologic urate-lowering therapy for patients with gout to achieve a goal serum uric acid (sUA) <6 mg/dL; however, little is known about other contributing factors. This study identified clinical characteristics of patients treated with febuxostat to develop and validate a predictive model for achieving a goal sUA. PATIENTS AND METHODS: Patients with Humana Medicare or commercial insurance, diagnosed with gout and newly initiated on febuxostat (index date February 1, 2009 – December 31, 2013), were identified for a retrospective cohort study. Patients were followed for 365 days and the first valid sUA test result ≥120 days after index was retained. A stepwise logistic regression with backward elimination was estimated to model sUA goal attainment, and a linear model was estimated to model the impact of predictor variables on sUA level. RESULTS: The study sample (n=678) was divided into a development (training) dataset (n=453) and a validation (holdout) dataset (n=225). In the training sample, patients in the sUA <6 mg/dL group were on febuxostat for a longer time, were more adherent, and had a lower average base-line sUA level (all p<0.0001) vs patients in the sUA ≥6 mg/dL group. In the logistic model, febuxostat adherence (odds ratio [OR]=1.03, p<0.0001) and baseline sUA level (OR=0.84, p<0.0001) increased the odds of attaining sUA <6 mg/dL. In the linear regression model, increase in febuxostat adherence (p<0.0001), baseline sUA level (p<0.0001), advanced age (p=0.0021), and not having congestive heart failure (p<0.05) were associated with a reduction of sUA level. Pre-index allopurinol use was a marginally significant predictor of sUA level reduction (p=0.06). CONCLUSIONS: Among febuxostat users diagnosed with gout in a real-world setting, adherence to febuxostat and lower baseline sUA level were the strongest predictors of attaining sUA goal. These findings may help clinicians to identify appropriate patients most likely to benefit from febuxostat treatment, and underscore the importance of medication adherence in this challenging patient population. |
format | Online Article Text |
id | pubmed-5644566 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-56445662017-10-24 Predictors of reaching a serum uric acid goal in patients with gout and treated with febuxostat Sheer, Richard Null, Kyle D Szymanski, Keith A Sudharshan, Lavanya Banovic, Jennifer Pasquale, Margaret K Clinicoecon Outcomes Res Original Research PURPOSE: Clinical guidelines recommend febuxostat as first-line pharmacologic urate-lowering therapy for patients with gout to achieve a goal serum uric acid (sUA) <6 mg/dL; however, little is known about other contributing factors. This study identified clinical characteristics of patients treated with febuxostat to develop and validate a predictive model for achieving a goal sUA. PATIENTS AND METHODS: Patients with Humana Medicare or commercial insurance, diagnosed with gout and newly initiated on febuxostat (index date February 1, 2009 – December 31, 2013), were identified for a retrospective cohort study. Patients were followed for 365 days and the first valid sUA test result ≥120 days after index was retained. A stepwise logistic regression with backward elimination was estimated to model sUA goal attainment, and a linear model was estimated to model the impact of predictor variables on sUA level. RESULTS: The study sample (n=678) was divided into a development (training) dataset (n=453) and a validation (holdout) dataset (n=225). In the training sample, patients in the sUA <6 mg/dL group were on febuxostat for a longer time, were more adherent, and had a lower average base-line sUA level (all p<0.0001) vs patients in the sUA ≥6 mg/dL group. In the logistic model, febuxostat adherence (odds ratio [OR]=1.03, p<0.0001) and baseline sUA level (OR=0.84, p<0.0001) increased the odds of attaining sUA <6 mg/dL. In the linear regression model, increase in febuxostat adherence (p<0.0001), baseline sUA level (p<0.0001), advanced age (p=0.0021), and not having congestive heart failure (p<0.05) were associated with a reduction of sUA level. Pre-index allopurinol use was a marginally significant predictor of sUA level reduction (p=0.06). CONCLUSIONS: Among febuxostat users diagnosed with gout in a real-world setting, adherence to febuxostat and lower baseline sUA level were the strongest predictors of attaining sUA goal. These findings may help clinicians to identify appropriate patients most likely to benefit from febuxostat treatment, and underscore the importance of medication adherence in this challenging patient population. Dove Medical Press 2017-10-10 /pmc/articles/PMC5644566/ /pubmed/29066924 http://dx.doi.org/10.2147/CEOR.S139939 Text en © 2017 Sheer et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. |
spellingShingle | Original Research Sheer, Richard Null, Kyle D Szymanski, Keith A Sudharshan, Lavanya Banovic, Jennifer Pasquale, Margaret K Predictors of reaching a serum uric acid goal in patients with gout and treated with febuxostat |
title | Predictors of reaching a serum uric acid goal in patients with gout and treated with febuxostat |
title_full | Predictors of reaching a serum uric acid goal in patients with gout and treated with febuxostat |
title_fullStr | Predictors of reaching a serum uric acid goal in patients with gout and treated with febuxostat |
title_full_unstemmed | Predictors of reaching a serum uric acid goal in patients with gout and treated with febuxostat |
title_short | Predictors of reaching a serum uric acid goal in patients with gout and treated with febuxostat |
title_sort | predictors of reaching a serum uric acid goal in patients with gout and treated with febuxostat |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644566/ https://www.ncbi.nlm.nih.gov/pubmed/29066924 http://dx.doi.org/10.2147/CEOR.S139939 |
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