Gout Patients Missed Out on Medication

Gout patients eligible for recommended urate lowering treatment often were not prescribed it

(RxWiki News) Gout is treatable, but many patients may not be receiving the specific medication recommended for them. Is price this reason?

In a new UK study, patients with gout were found to wait years before being eligible for the recommended urate-lowering treatment. But even after becoming eligible, most patients still did not receive the treatment.

Chang-Fu Kuo, MD, of Chang Gung Memorial Hospital in Taoyuan, Taiwan, and colleagues studied the prescription of urate-lowering treatment for patients after their first diagnosis of gout.

“Our study supports including urate-lowering treatment in the information about gout provided to patients around the time of first diagnosis,” Dr. Kuo and team wrote.

Gout is when the joints have too much buildup of uric acid. The swelling and pain from gout are caused by urate crystals being deposited in the joints. Urate-lowering treatment has been highly recommended because it stops urate crystal buildup and dissolves crystals in severe cases.

Using the Clinical Practice Research Datalink, these researchers studied a total of 52,164 patients who were diagnosed with gout from 1997 to 2010.

On average, it took about five months before a patient started showing symptoms and was advised on which treatment to take, Dr. Kuo and team found.

Among patients recently diagnosed with gout, 44 percent were eligible for urate-lowering treatment. None of those patients, however, were prescribed the treatment.

At one year from gout diagnosis, 61 percent of the patients were eligible for urate-lowering treatment, but only 17 percent received it.

At five years from diagnosis, 87 percent of patients were eligible for the treatment, but only 30 percent were prescribed it.

At 10 years from diagnosis, 94 percent of patients were eligible for treatment, but only 41 percent actually received the treatment.

Dr. Kuo explained to dailyRx News that general practitioners prescribe treatments and determine eligibility for patients based on advice from major professional organizations (such as the European League Against Rheumatism and American College of Rheumatology).

“In general, current consensus suggests patients with more severe gout (more frequent attacks) and those with other [simultaneous] diseases (such as renal diseases) should be treated,” Dr. Kuo said.

Dr. Kuo and colleagues estimated that about a third of practices in England prescribed urate-lowering treatment to patients with gout from 1997 to 2010.

The difference in prescription rates among the practices partly depended on the doctor or patient, Dr. Kuo and team found. Some doctors, for instance, may not see gout as a serious disease, while others might.

Dr. Kuo said that “many patients tend not to receive daily medication for a perceived minor disease. This could also potentially affect prescription rate.”

Patients who didn't receive the urate-lowering treatment did often receive other treatments, Dr. Kuo said. These treatments included anti-inflammatory medications (like ibuprofen or colchicine) and pain relievers (like paracetamol).

This study was published online Dec. 24 in JAMA.

The National Science Council of Taiwan and Chang Gung Memorial Hospital funded the research.

Study author Dr. Weiya Zhang received funds from Daiichi Sankyo, a global pharmaceutical company. Study author Dr. Michael Doherty also received funds from AstraZeneca, Menarini, Nordic Biosciences, Novartis and Pfizer.

Review Date: 
December 23, 2014