Can racial disparities in optimal gout treatment be reduced? evidence from a randomized trial

BMC Medicine

Jasvinder A Singh¹ 

[1] Medicine Service, Birmingham VA Medical Center and Department of Medicine, University of Alabama, Birmingham, AL, USA

关键词: African-American;    randomized;    Allopurinol;    Febuxostat;    treatment;    Race;    Disparity;    Gout;   

Others  :  1126408
DOI  :  10.1186/1741-7015-10-15

 received in 2012-01-18, accepted in 2012-02-09,  发布年份 2012

【 摘 要 】

There is a disproportionate burden of gout in African-Americans in the U.S. due to a higher disease prevalence and lower likelihood of receiving urate-lowering therapy (ULT), compared to Caucasians. There is an absence of strong data as to whether the response to ULT differs by race/ethnicity. BMC Musculoskeletal Disorders recently published a secondary analyses of the CONFIRMS trial, a large randomized controlled, double-blind trial of 2,269 gout patients. The authors reported that the likelihood of achieving the primary study efficacy end-point of achieving serum urate < 6 mg/dl was similar between African-Americans and Caucasians, for all three treatment arms (Febuxostat 40 mg and 80 mg and allopurinol 300/200 mg). More importantly, rates were similar in subgroups of patients with mild or moderate renal insufficiency. Adverse event rates were similar, as were the rates of gout flares. These findings constitute a convincing evidence to pursue aggressive ULT in gout patients, regardless of race/ethnicity. This approach will likely help to narrow the documented racial disparities in gout care.

Please see related article: http://www.biomedcentral.com/1471-2474/13/15 webcite

【 授权许可】

   
2012 Singh; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Zhu Y, Pandya BJ, Choi HK: Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum 2011, 63(10):3136-3141.
• [2]Wallace KL, Riedel AA, Joseph-Ridge N, Wortmann R: Increasing prevalence of gout and hyperuricemia over 10 years among older adults in a managed care population. J Rheumatol 2004, 31(8):1582-1587.
• [3]Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, Liang MH, Kremers HM, Mayes MD, Merkel PA, et al.: Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum 2008, 58(1):15-25.
• [4]Krishnan E, Baker JF, Furst DE, Schumacher HR: Gout and the risk of acute myocardial infarction. Arthritis Rheum 2006, 54(8):2688-2696.
• [5]Krishnan E, Svendsen K, Neaton JD, Grandits G, Kuller LH: Long-term cardiovascular mortality among middle-aged men with gout. Arch Intern Med 2008, 168(10):1104-1110.
• [6]Choi HK, Curhan G: Independent impact of gout on mortality and risk for coronary heart disease. Circulation 2007, 116(8):894-900.
• [7]De Vera MA, Rahman MM, Bhole V, Kopec JA, Choi HK: Independent impact of gout on the risk of acute myocardial infarction among elderly women: a population-based study. Ann Rheum Dis 2010, 69(6):1162-1164.
• [8]Neogi T: Clinical practice. Gout. N Engl J Med 2011, 364(5):443-452.
• [9]Sarawate CA, Patel PA, Schumacher HR, Yang W, Brewer KK, Bakst AW: Serum urate levels and gout flares: analysis from managed care data. J Clin Rheumatol 2006, 12(2):61-65.
• [10]Singh JA, Hodges JS, Asch SM: Opportunities for improving medication use and monitoring in gout. Ann Rheum Dis 2009, 68(8):1265-1270.
• [11]Shoji A, Yamanaka H, Kamatani N: A retrospective study of the relationship between serum urate level and recurrent attacks of gouty arthritis: evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy. Arthritis Rheum 2004, 51(3):321-325.
• [12]Schumacher HR Jr, Becker MA, Lloyd E, MacDonald PA, Lademacher C: Febuxostat in the treatment of gout: 5-yr findings of the FOCUS efficacy and safety study. Rheumatology (Oxford) 2009, 48(2):188-194.
• [13]Becker MA, Schumacher HR, MacDonald PA, Lloyd E, Lademacher C: Clinical efficacy and safety of successful longterm urate lowering with febuxostat or allopurinol in subjects with gout. J Rheumatol 2009, 36(6):1273-1282.
• [14]Becker MA, MacDonald PA, Hunt BJ, Lademacher C, Joseph-Ridge N: Determinants of the clinical outcomes of gout during the first year of urate-lowering therapy. Nucleosides Nucleotides Nucleic Acids 2008, 27(6):585-591.
• [15]Halpern R, Fuldeore MJ, Mody RR, Patel PA, Mikuls TR: The effect of serum urate on gout flares and their associated costs: an administrative claims analysis. J Clin Rheumatol 2009, 15(1):3-7.
• [16]Hochberg MC, Thomas J, Thomas DJ, Mead L, Levine DM, Klag MJ: Racial differences in the incidence of gout. The role of hypertension. Arthritis Rheum 1995, 38(5):628-632.
• [17]Krishnan E, Lienesch D, Kwoh CK: Gout in ambulatory care settings in the United States. J Rheumatol 2008, 35(3):498-501.
• [18]IOM. 2003. Unequal treatment: Confronting racial and ethnic disparities in health care Washington, DC: The National Academies Press; 2003.
• [19]Wells AF, MacDonald PA, Chefo S, Jackson RL: African American Patients with gout: Efficacy and safety of febuxostat vs allopurinol. BMC Musculoskelet Disord 2012, 13:15. BioMed Central Full Text
• [20]Sarawate CA, Brewer KK, Yang W, Patel PA, Schumacher HR, Saag KG, Bakst AW: Gout medication treatment patterns and adherence to standards of care from a managed care perspective. Mayo Clin Proc 2006, 81(7):925-934.
• [21]Dalbeth N, Kumar S, Stamp L, Gow P: Dose adjustment of allopurinol according to creatinine clearance does not provide adequate control of hyperuricemia in patients with gout. J Rheumatol 2006, 33(8):1646-1650.
• [22]Mikuls TR, MacLean CH, Olivieri J, Patino F, Allison JJ, Farrar JT, Bilker WB, Saag KG: Quality of care indicators for gout management. Arthritis Rheum 2004, 50(3):937-943.
• [23]Morgan RC Jr, Slover J: Breakout session: Ethnic and racial disparities in joint arthroplasty. Clin Orthop Relat Res 2011, 469(7):1886-1890.
• [24]Skinner J, Weinstein JN, Sporer SM, Wennberg JE: Racial, ethnic, and geographic disparities in rates of knee arthroplasty among Medicare patients. N Engl J Med 2003, 349(14):1350-1359.
• [25]Lavernia CJ, Alcerro JC, Contreras JS, Rossi MD: Ethnic and racial factors influencing well-being, perceived pain, and physical function after primary total joint arthroplasty. Clin Orthop Relat Res 2011, 469(7):1838-1845.
• [26]Constantinescu F, Goucher S, Weinstein A, Fraenkel L: Racial disparities in treatment preferences for rheumatoid arthritis. Med Care 2009, 47(3):350-355.