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Serum Urate Levels and Gout Flares: Analysis From Managed Care Data

Sarawate, Chaitanya A. MS*; Patel, Pankaj A. MS, PharmD; Schumacher, H Ralph MD; Yang, Wenya MPA*; Brewer, Kathleen K. MS, PhD*; Bakst, Alan W. MBA, PharmD

JCR: Journal of Clinical Rheumatology: April 2006 - Volume 12 - Issue 2 - p 61-65
doi: 10.1097/01.rhu.0000209882.50228.9f
Original Article

Background: The desired serum urate level (SUA) for prevention of gout attacks is widely recommended to be in the subsaturating range, <6.0 mg/dL.

Objectives: The objectives of this study were to evaluate attainment of this target SUA among gout patients on allopurinol in a naturalistic setting and to assess its impact on gout flare risk.

Methods: This was a retrospective, observational study in a southeastern U.S. managed care organization of approximately 2.2 million members. The first gout claim/prescription within the intake period (January 1, 2000–December 31, 2002) was the index date. Included patients had ≥2 visits with gout International Classification of Diseases, 9th Revision code (274.xx) or ≥1 pharmacy script(s) for allopurinol, colchicine, probenecid, or sulfinpyrazone. Excluded patients were <18 years and/or did not have a 1-year continuous eligibility pre-/postindex date. Gout flares were defined by office/emergency room visit with gout or joint pain code(s) and ≥1 of the following within 7 days of the visit: intraarticular aspiration/injection, joint fluid microscopy, or pharmacy claim for nonsteroidal antiinflammatory drug, colchicine, corticosteroid, or ACTH. Multivariable regression analyses were conducted to evaluate gout flare risk/rate and association with target SUA.

Results: Approximately 40% of 5942 gout patients identified used allopurinol postindex. Among allopurinol users with pre-/postindex SUA data (n = 162), mean SUA was lowered from 8.7 mg/dL to 7.1 mg/dL; reduction was significant (P < 0.001). Among allopurinol users who did not have SUA <6.0 mg/dL preindex (n = 147), only 25% reached target levels during postindex. Despite pharmacotherapy, patients with nontarget levels were 59% more likely to flare than those at target. Allopurinol users who were not at target were 75% more likely to flare.

Conclusion: The failure of allopurinol users to achieve target SUA levels of <6.0 mg/dL may be attributed to lack of awareness of optimal SUA, allopurinol dosing, compliance, and efficacy. Patients who did not achieve target SUA were at increased flare risk.

Data from a managed care cohort demonstrate that many patients with gout do not reach the proposed target urate of <6 mg/dL and have more frequent flares than those who do reach the target. Allopurinol as prescribed with doses rarely above 300 mg was not as effective as anticipated.

From *HealthCore, Inc., Wilmington, Delaware; †TAP Pharmaceutical Products, Inc., Lake Forest, Illinois; and the ‡University of Pennsylvania and Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania.

This study was funded by a grant from TAP Pharmaceutical Products, Inc. Abstracts of this data were presented at the International Society for Pharmacoeconomics and Outcomes Research 10th Annual Meeting, Washington, DC, May 14–16, 2005.

Reprints: Chaitanya Sarawate, MS, Manager, Analytics, Health Outcomes Research, HealthCore, Inc., 800 Delaware Ave., Fifth Floor, Wilmington, DE 19801-1366. E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.