Urate-lowering therapy for gout and asymptomatic hyperuricemia in the pediatric population: a cross-sectional study of a Japanese health insurance database

BMC Pediatrics

Masataka Honda¹  Shuichi Ito²  Hideki Horiuchi³  Tomoko Torii³  Akihiro Nakajima⁴  Takeshi Iijima⁵  Hiroshi Murano⁵  Hisashi Yamanaka⁶ 

[1] Clinical Research Support Center, Tokyo Metropolitan Children’s Medical Center, Musashidai 2-8-29, 183-8561, Fuchu-shi, Tokyo, Japan;Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Fukuura 3-9, Kanazawa-ku, 236-0004, Yokohama-shi, Kanagawa, Japan;Medical Science Department, Teijin Pharma Limited, Kasumigaseki Common Gate West Tower, Kasumigaseki 3-2-1, 100-8585, Chiyoda-ku, Tokyo, Japan;Pharmaceutical Development Administration Department, Teijin Pharma Limited, Kasumigaseki Common Gate West Tower, Kasumigaseki 3-2-1, 100-8585, Chiyoda-ku, Tokyo, Japan;Pharmaceutical Development Coordination Department, Teijin Pharma Limited, Kasumigaseki Common Gate West Tower, Kasumigaseki 3-2-1, 100-8585, Chiyoda-ku, Tokyo, Japan;Rheumatology, Sanno Medical Center, Akasaka 8-5-35, 107-0052, Minato-ku, Tokyo, Japan;Department of Rheumatology, International University of Health and Welfare, Kozunomori 4-3, 286-8686, Narita-shi, Chiba, Japan;Institute of Rheumatology, Tokyo Women’s Medical University, Kawada-cho 8-1, 162-8666, Shinjuku-ku, Tokyo, Japan;

关键词: Database;    Epidemiology;    Gout;    Hyperuricemia;    Children;    Hyperuricemia drug therapy;   

DOI  :  10.1186/s12887-021-03051-x

来源: Springer

【 摘 要 】

BackgroundOur previous research showed that uric acid lowering therapy (ULT) for gout and hyperuricemia is being prescribed for pediatric patients even though these drugs have not been approved for use in children. However, the actual clinical situation has not been clearly elucidated. In this paper, we provide an in-depth look at the details of actual clinical practice.MethodsThis retrospective cross-sectional study accessed health insurance data for 696,277 children from April 2016 through March 2017 to identify pediatric patients with gout or asymptomatic hyperuricemia, calculate the proportion of patients prescribed ULTs, and analyze population characteristics. Adherence and mean dose for febuxostat and allopurinol, the most commonly prescribed drugs, were also analyzed.ResultsAmong children with gout or asymptomatic hyperuricemia, we found that 35.1% (97/276) were prescribed ULT. This proportion increased with age, especially among males. By comorbidity, ULT was prescribed to 47.9% (46/96) of patients with kidney disease, 41.3% (26/63) for cardiovascular disease, 40.0% (6/15) for Down syndrome, and 27.1% (32/118) for metabolic syndrome. In patients with kidney disease, febuxostat was prescribed more than twice as frequently as allopurinol (28 vs. 12). Median values for the medication possession ratio (MPR) of febuxostat and allopurinol were 70.1 and 76.7%, respectively, and prescriptions were continued for a relatively long period for both drugs. Both drugs were prescribed at about half the adult dose for patients 6–11 years old and about the same as the adult dose for patients 12–18 years old.ConclusionsThis study showed that the continuous management of serum uric acid is being explored using off-label use of ULT in pediatric patients with gout or asymptomatic hyperuricemia in Japan. Drug selection is based on patient characteristics such as sex, age, and comorbidities, and pediatric dosage is based on usage experience in adults. To develop appropriate pediatric ULT, clinical trials are needed on the efficacy and safety of ULT in the pediatric population.Trial registrationUMIN000036029.

【 授权许可】

CC BY