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Arthritis Res Ther. 2015 May 12;17:120. doi: 10.1186/s13075-015-0624-3.

Comparative effectiveness of urate lowering with febuxostat versus allopurinol in gout: analyses from large U.S. managed care cohort.

Author information

1
Medicine Service and Center for Surgical Medical Acute care Research and Transitions (C-SMART), Birmingham VA Medical Center, 700 South 19th Street, Birmingham, AL, 35233, USA. jassingh@uab.edu.
2
Department of Medicine at School of Medicine, University of Alabama, 1670 University Boulevard, Birmingham, AL, 35233, USA. jassingh@uab.edu.
3
Division of Epidemiology at School of Public Health, University of Alabama, 1665 University Boulevard, Birmingham, AL, 35233, USA. jassingh@uab.edu.
4
Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA. jassingh@uab.edu.
5
University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA. jassingh@uab.edu.
6
Takeda Pharmaceuticals International, Inc., One Takeda Parkway, Deerfield, IL, 60015, USA. kasem08a@msn.com.
7
Takeda Pharmaceuticals International, Inc., One Takeda Parkway, Deerfield, IL, 60015, USA. aki.shiozawa@takeda.com.

Abstract

INTRODUCTION:

To assess the comparative effectiveness of febuxostat and allopurinol in reducing serum urate (sUA) levels in a real-world U.S. managed care setting.

METHODS:

This retrospective study utilized 2009 to 2012 medical and pharmacy claims and laboratory data from a large U.S. commercial and Medicare Advantage health plan. Study patients had at least one medical claim with a diagnosis of gout, at least one filled prescription for febuxostat or allopurinol and at least one sUA measurement post-index prescription. Reduction in sUA was examined using propensity score-matched cohorts, matched on patient demographics (gender, age), baseline sUA, comorbidities, geographic region and insurance type.

RESULTS:

The study sample included 2,015 patients taking febuxostat and 14,025 taking allopurinol. At baseline, febuxostat users had a higher Quan-Charlson comorbidity score (0.78 vs. 0.53; P <0.001), but similar age and gender distribution. Mean (standard deviation (SD)) sUA level following propensity score matching among treatment-naïve febuxostat vs. allopurinol users (n = 873 each) were: pre-index sUA, 8.86 (SD, 1.79) vs. 8.72 (SD, 1.63; P = 0.20); and post-index sUA, 6.53 (SD, 2.01) vs. 6.71 (SD, 1.70; P = 0.04), respectively. A higher proportion of febuxostat users attained sUA goals of <6.0 mg/dl (56.9% vs. 44.8%; P <0.001) and <5.0 mg/dl (35.5% vs. 19.2%; P <0.001), respectively. Time to achieve sUA goals of <6.0 mg/dl (346 vs. 397 days; P <0.001) and <5.0 mg/dl was shorter in febuxostat vs. allopurinol users (431 vs. 478 days; P <0.001), respectively. Similar observations were made for overall propensity score-matched cohorts that included both treatment-naïve and current users (n = 1,932 each).

CONCLUSIONS:

Febuxostat was more effective than allopurinol at the currently used doses (40 mg/day for febuxostat in 83% users and 300 mg/day or lower for allopurinol in 97% users) in lowering sUA in gout patients as demonstrated by post-index mean sUA level, the likelihood of and the time to achieving sUA goals.

PMID:
25963969
PMCID:
PMC4427980
DOI:
10.1186/s13075-015-0624-3
[Indexed for MEDLINE]
Free PMC Article

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