Prevalence of Contraindications and Prescription of Pharmacologic Therapies for Gout - 19/08/11
, William R. O'Brien, MD a, b, Kristen H. Lee, MD a, b, Daria B. Crittenden, MD a, b, Mark C. Fisher, MD, MPH a, b, David S. Goldfarb, MD c, d, Svetlana Krasnokutsky, MD, MS a, b, Cheongeun Oh, PhD e, Michael H. Pillinger, MD a, b
Requests for reprints should be addressed to Robert T. Keenan, MD, MPH, Assistant Professor of Medicine, Division of Rheumatology, 200 Trent Drive DUMC 3544, Duke University Medical Center, Durham, NC 27710Abstract |
Background |
Patients with gout have comorbidities, but the impact of these comorbidities on treatment has not been studied.
Methods |
A total of 575 patients with gout were stratified according to certainty of diagnosis according to International Classification of Diseases, 9th Revision, Clinical Modification code alone (cohort I), American College of Radiology criteria (cohort II), and crystal diagnosis (cohort III). Comorbid conditions were defined according to International Classification of Diseases, 9th Revision, Clinical Modification codes, and stratified as either moderate or severe. Drug contraindications were defined as moderate or strong, based on Food and Drug Administration criteria and severity of disease.
Results |
The most common comorbidity was hypertension (prevalence 0.89). The presence of comorbidities resulted in a high frequency of contraindications to approved gout medications. More than 90% of patients had at least 1 contraindication to nonsteroidal anti-inflammatory drugs. Many patients demonstrated multiple contraindications to 1 or more gout medications. Frequently, patients were prescribed medications to which they harbored contraindications. The prevalence of patients prescribed colchicine despite having at least 1 strong contraindication was 30% (cohort I), 37% (cohort II), and 39.6% (cohort III).
Conclusion |
Patients with gout typically harbor multiple comorbidities that result in contraindications to many of the medications available to treat gout. Frequently, despite contraindications to gout therapies, patients are frequently prescribed these medications.
Le texte complet de cet article est disponible en PDF.Keywords : Comorbidity, Drug contraindication, Gout, Quality of care, Treatment
Plan
| Funding: Drs Keenan and Fisher were supported by National Institutes of Health T32 Training Grant 5T32AR007176. Dr Fisher also was the recipient of Fellowship Training Award from the Arthritis Foundation New York Chapter. No other external funding was used. |
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| Conflict of Interest: Dr Goldfarb is a consultant for Takeda. None of the other authors have any conflict of interest regarding this manuscript. |
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| Authorship: All authors had access to the data and played a role in writing this manuscript. |
Vol 124 - N° 2
P. 155-163 - février 2011 Retour au numéro
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