Practical application of national clinical guidelines for the management of gout (preliminary data)
The 2018 national guidelines for the management of gout provide a consistent scheme for urate-lowering drugs; however, the possibility of achieving uric acid (UA) targets in its use has not been studied.Objective: to evaluate the effectiveness and safety of the urate-lowering therapy algorithm prese...
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2020-05-01
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| author | M. N. Chikina M. S. Eliseev O. V. Zhelyabina |
| author_facet | M. N. Chikina M. S. Eliseev O. V. Zhelyabina |
| author_sort | M. N. Chikina |
| collection | DOAJ |
| description | The 2018 national guidelines for the management of gout provide a consistent scheme for urate-lowering drugs; however, the possibility of achieving uric acid (UA) targets in its use has not been studied.Objective: to evaluate the effectiveness and safety of the urate-lowering therapy algorithm presented in the national guidelines for the management of gout.Patients and methods. This investigation was a prospective single-center study. It has been currently included 54 patients (91% males) with gout. The follow-up period is not less than 12 weeks of continuous use of allopurinol or febuxostat (Azurix) at the final dose.After the initiation of urate-lowering therapy, allopurinol 100 mg/day was prescribed, followed by dose titration to achieve the UA target that was defined as <360 or <300 μmol/L in patients with severe tophaceous gout. The maximum dose was 900 mg/day; it was 300 mg/day when the glomerular filtration rate was <60 ml/min/1.73 m2 . Patients with the inefficacy of allopurinol and/or the presence of its associated adverse reactions (ARs) were prescribed febuxostat 80 mg/day; the dose was increased to 120 mg/day as needed.For the prevention of acute arthritis attacks, all the patients received a nonsteroidal anti-inflammatory drug (NSAID) at the minimum therapeutic doses or colchicine 0.5 mg/day, and if these drugs were contraindicated, a glucocorticoid (GC) 7.5 mg/day, as calculated with reference to prednisone, was taken.The probability of achieving the serum UA target (<360 or 300 μmol/L) was assessed in patients with chronic tophaceous gout.Results and discussion. 12 weeks after therapy initiation, the UA target could be achieved in 39/50 (79%) patients. The target levels <360 and 360 μmol/L were recorded in 15/21 (71%) and 24/33 (73%), respectively. The UA level <360 μmol/L was noted to decrease in a total of 92% of cases. Febuxostat was given to 41 patients: to 27 (66%) due to the inefficacy of allopurinol and to 14 (34%) due to its ARs. As a result, the UA target was achieved in 30 (73%) patients, and there was a decrease in the UA level <360 μmol/L in 35 (85%).ARs were seen only in 3 febuxostat-treated patients, including 2 patients with previous allopurinol-induced ARs.For the prevention of arthritis attacks, 10 (19%) patients took NSAIDs, 41 (75%) received colchicine, and 3 (6%) used GC. There were no refusals to receive urate-lowering and preventive anti-inflammatory therapies.Conclusion. The proposed treatment regimen allows for achieving the serum UA target in 79% of patients and its decrease <360 μmol/L in 92%. Treatment with febuxostat (Azurix) is associated with its good tolerance, including in the patients who could not use allopurinol because of AR. Preventive anti-inflammatory therapy is likely to improve adherence to urate-lowering therapy. |
| format | Article |
| id | doaj-art-121e19acc3144d2f86c66c1d759798de |
| institution | DOAJ |
| issn | 1996-7012 2310-158X |
| language | Russian |
| publishDate | 2020-05-01 |
| publisher | IMA-PRESS LLC |
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| series | Современная ревматология |
| spelling | doaj-art-121e19acc3144d2f86c66c1d759798de2025-08-20T03:20:58ZrusIMA-PRESS LLCСовременная ревматология1996-70122310-158X2020-05-011429710310.14412/1996-7012-2020-2-97-1032266Practical application of national clinical guidelines for the management of gout (preliminary data)M. N. Chikina0M. S. Eliseev1O. V. Zhelyabina2V.A. Nasonova Research Institute of RheumatologyV.A. Nasonova Research Institute of RheumatologyV.A. Nasonova Research Institute of RheumatologyThe 2018 national guidelines for the management of gout provide a consistent scheme for urate-lowering drugs; however, the possibility of achieving uric acid (UA) targets in its use has not been studied.Objective: to evaluate the effectiveness and safety of the urate-lowering therapy algorithm presented in the national guidelines for the management of gout.Patients and methods. This investigation was a prospective single-center study. It has been currently included 54 patients (91% males) with gout. The follow-up period is not less than 12 weeks of continuous use of allopurinol or febuxostat (Azurix) at the final dose.After the initiation of urate-lowering therapy, allopurinol 100 mg/day was prescribed, followed by dose titration to achieve the UA target that was defined as <360 or <300 μmol/L in patients with severe tophaceous gout. The maximum dose was 900 mg/day; it was 300 mg/day when the glomerular filtration rate was <60 ml/min/1.73 m2 . Patients with the inefficacy of allopurinol and/or the presence of its associated adverse reactions (ARs) were prescribed febuxostat 80 mg/day; the dose was increased to 120 mg/day as needed.For the prevention of acute arthritis attacks, all the patients received a nonsteroidal anti-inflammatory drug (NSAID) at the minimum therapeutic doses or colchicine 0.5 mg/day, and if these drugs were contraindicated, a glucocorticoid (GC) 7.5 mg/day, as calculated with reference to prednisone, was taken.The probability of achieving the serum UA target (<360 or 300 μmol/L) was assessed in patients with chronic tophaceous gout.Results and discussion. 12 weeks after therapy initiation, the UA target could be achieved in 39/50 (79%) patients. The target levels <360 and 360 μmol/L were recorded in 15/21 (71%) and 24/33 (73%), respectively. The UA level <360 μmol/L was noted to decrease in a total of 92% of cases. Febuxostat was given to 41 patients: to 27 (66%) due to the inefficacy of allopurinol and to 14 (34%) due to its ARs. As a result, the UA target was achieved in 30 (73%) patients, and there was a decrease in the UA level <360 μmol/L in 35 (85%).ARs were seen only in 3 febuxostat-treated patients, including 2 patients with previous allopurinol-induced ARs.For the prevention of arthritis attacks, 10 (19%) patients took NSAIDs, 41 (75%) received colchicine, and 3 (6%) used GC. There were no refusals to receive urate-lowering and preventive anti-inflammatory therapies.Conclusion. The proposed treatment regimen allows for achieving the serum UA target in 79% of patients and its decrease <360 μmol/L in 92%. Treatment with febuxostat (Azurix) is associated with its good tolerance, including in the patients who could not use allopurinol because of AR. Preventive anti-inflammatory therapy is likely to improve adherence to urate-lowering therapy.https://mrj.ima-press.net/mrj/article/view/1025gouttreatmenturate-lowering drugsnational clinical guidelines |
| spellingShingle | M. N. Chikina M. S. Eliseev O. V. Zhelyabina Practical application of national clinical guidelines for the management of gout (preliminary data) Современная ревматология gout treatment urate-lowering drugs national clinical guidelines |
| title | Practical application of national clinical guidelines for the management of gout (preliminary data) |
| title_full | Practical application of national clinical guidelines for the management of gout (preliminary data) |
| title_fullStr | Practical application of national clinical guidelines for the management of gout (preliminary data) |
| title_full_unstemmed | Practical application of national clinical guidelines for the management of gout (preliminary data) |
| title_short | Practical application of national clinical guidelines for the management of gout (preliminary data) |
| title_sort | practical application of national clinical guidelines for the management of gout preliminary data |
| topic | gout treatment urate-lowering drugs national clinical guidelines |
| url | https://mrj.ima-press.net/mrj/article/view/1025 |
| work_keys_str_mv | AT mnchikina practicalapplicationofnationalclinicalguidelinesforthemanagementofgoutpreliminarydata AT mseliseev practicalapplicationofnationalclinicalguidelinesforthemanagementofgoutpreliminarydata AT ovzhelyabina practicalapplicationofnationalclinicalguidelinesforthemanagementofgoutpreliminarydata |