scholarly journals Adherence to urate-lowering therapy while following the national guidelines for the management of patients with gout (preliminary evidence)

2020 ◽  
Vol 14 (4) ◽  
pp. 70-75
Author(s):  
M. N. Chikina ◽  
E. V. Ilyinykh ◽  
M. S. Eliseev
Keyword(s):  
Patient Adherence ◽  
Preliminary Evidence ◽  
Dose Titration ◽  
National Guidelines ◽  
Tophaceous Gout ◽  
Antiinflammatory Therapy ◽  
Lowering Therapy ◽  
Anti Inflammatory ◽  
Therapeutic Doses

Low compliance in patients with gout is one of the reasons for inadequate disease control.Objective: to study treatment adherence in compliance with the national guidelines for the management of gout patients, which provide for the continuous use of urate-lowering drugs, a gradual increase in their dose until the target serum uric acid (UA) level is reached, prophylactic antiinflammatory therapy, and regular patient monitoring.Patients and methods. This was a prospective single-center study. By now, 60 of the 80 enrolled gout patients had completed the study. The follow-up period was at least 24 weeks, during which allopurinol or febuxostat was used at the final dose. During initiation of urate-lowering therapy, allopurinol 100 mg/day was prescribed, followed by dose titration to reach the target UA level (<360 μmol/L) for all patients or <300 μmol/L for those with severe tophaceous gout. Patients with ineffective allopurinol and/or in the presence of its associated adverse reactions were prescribed febuxostat (Azurix®) 80 mg/day; the dose was increased up to 120 mg/day as needed. To prevent acute arthritis attacks, all the patients received a nonsteroidal anti-inflammatory drug (NSAID) at minimal therapeutic doses or colchicine 0.5 mg/day, and in the presence of contraindications to their use, they took glucocorticoid (GC) 7.5 mg/day calculated with reference to prednisolone. The four-item Morisky–Green questionnaire was used to assess patient adherence to therapy.Results and discussion. At 24 weeks after the start of their follow-up, 53 (88%) of the 60 patients received urate-lowering therapy; 38 (72%) of these 53 patients achieved the target UA level. The dose of allopurinol was titrated in 19 patients; and 10 (53%) of them achieved the target serum UA levels. Due to its inefficacy, allopurinol was replaced by febuxostat in 24 patients. In this group, the target UA level was recorded in 16 (67%) patients. Seventeen patients were immediately prescribed febuxostat that could achieve the target UA level in 12 (71%) of them. All the patients enrolled in the study received prophylactic anti-inflammatory therapy: NSAIDs were used in 9 (15%) patients, colchicine and GC were given to 46 (77%) and 5 (8%), respectively. Twenty-six (49%) patients who had completed the investigation were ascertained to have a high adherence therapy. Moderate and low adherence was observed in 9 (17%) and 18 (34%) patients, respectively. High therapy adherence was noted in more than half of cases in the febuxostat group and in 40% in the allopurinol one.Conclusion. High compliance in gout patients can be achieved through the observance of the national guidelines for the treatment of this disease.

scholarly journals Practical application of national clinical guidelines for the management of gout (preliminary data)

2020 ◽  
Vol 14 (2) ◽  
pp. 97-103
Author(s):  
M. N. Chikina ◽  
M. S. Eliseev ◽  
O. V. Zhelyabina
Keyword(s):  
Dose Titration ◽  
National Guidelines ◽  
Tophaceous Gout ◽  
Therapy Algorithm ◽  
Lowering Therapy ◽  
Single Center Study ◽  
Anti Inflammatory ◽  
Therapeutic Doses ◽  
Continuous Use

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.

scholarly journals Comparison of the efficacy and safety of various anti-inflammatory drugs in urate-lowering therapy initiation in patients with gout (preliminary data)

2021 ◽  
Vol 15 (2) ◽  
pp. 50-56
Author(s):  
M. N. Chikina ◽  
M. S. Eliseev ◽  
O. V. Zhelyabina
Keyword(s):  
Dose Titration ◽  
Control Group ◽  
Efficacy And Safety ◽  
Minimum Effective Dose ◽  
Good Tolerance ◽  
Drug Of Choice ◽  
Lowering Therapy ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Non-steroidal anti-inflammatory drugs (NSAIDs), colchicine and glucocorticoids (GC) are used to prevent arthritis attacks in gout, but data on their comparative effectiveness is lacking.Objective: to compare the efficacy and safety of various anti-inflammatory drugs at the start of treatment in patients with gout.Patients and methods. Of the 108 patients with gout, observed in the V.A. Nasonova Research Institute of Rheumatology, 97 (94%), mostly men, entered a single-center prospective study. The observation period was at least 24 weeks, patients received combined urate-lowering and prophylactic anti-inflammatory therapy unintermittingly. The control group included 12 patients in whom anti-inflammatory drugs were contraindicated. At the start of urate-lowering therapy, allopurinol 100 mg per day was prescribed, followed by dose titration until the target uric acid (UA) level of < 360 μmol/L level was reached, in patients with severe tophus gout it was < 300 μmol/L. The maximum dose of allopurinol was 900 mg per day; in patients with reduced glomerular filtration rate (<60 ml/min/1.73m2 ) – 300 mg per day. For the prevention of arthritis attacks, the drug of choice was colchicine 0.5 mg per day, when contraindicated and/or poorly tolerated, NSAIDs were prescribed in the minimum effective dose. If there were any NSAIDs use restriction or intolerance – prednisone 7.5 mg per day was administered. The effectiveness of anti-inflammatory therapy (NSAIDs, colchicine or GC) was evaluated after 3 and 6 months which included analysis of the frequency of exacerbations and the duration of arthritis attacks, the intensity of pain according to the visual analogue scale (VAS) during a gout attack.Results and discussion. Of 97 patients with gout, 85 (88%) received anti-inflammatory therapy: NSAIDs – 16 (19%), colchicine – 60 (71%), GC – 9 (10%). In 65% of patients who were administered anti-inflammatory therapy, there were no recurrence of arthritis, whereas in 12 patients of the control group who did not receive this treatment, recurrence of arthritis was absent only in 25% of cases (p=0.008). After 3 and 6 months of follow-up, the duration of gout attacks and the intensity of joint pain according to the VAS for recurrent arthritis were significantly less (p< 0.05 in both cases) in the treatment group (with any anti-inflammatory drug) than without treatment. Arthritis attacks were more likely to be absent when taking NSAIDs than when using colchicine and GC both after 3 (63%) and 6 (81%) months (p< 0.05 in both cases). After 3 months of observation, the intensity of pain according to the VAS during the development of a gout attack was less for NSAIDs therapy than for colchicine and GC (p< 0.05 in both cases), and after 6 months there was no difference between NSAIDs, colchicine and GC. Within first 3 months, there was no difference in the duration of arthritis attacks among anti-inflammatory drugs, whereas after 6 months duration of attacks was the smallest for NSAID therapy (p< 0.05). Adverse reactions occurred only in NSAID and colchicine therapy in 2 and 5 patients, respectively. The patient's refusal to continue therapy without cause occurred in 13 (15%) cases, more often when taking colchicine.Conclusion. The proposed algorithm of anti-inflammatory drugs prescription for prevention of arthritis recurrence can reduce the risk of gout attacks development with good tolerance of the therapy. At the same time, better control of the frequency and duration of arthritis attacks, as well as the intensity of pain according to the VAS, is observed with the use of NSAIDs than with the use of colchicine and GC.

scholarly journals Interventions to improve uptake of urate-lowering therapy in patients with gout: a systematic review

BJGP Open ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. bjgpopen20X101051 ◽  
Author(s):  
Iqbal Gill ◽  
Nicola Dalbeth ◽  
Malakai 'Ofanoa ◽  
Felicity Goodyear-Smith
Keyword(s):  
Systematic Review ◽  
Patient Education ◽  
Illness Perceptions ◽  
Patient Adherence ◽  
Serum Urate ◽  
Primary Care Settings ◽  
Lowering Therapy ◽  
Included Patient ◽  
Medication Dosage

BackgroundGout treatment is suboptimal despite available therapy, with low levels of initiation and persistence of urate-lowering therapy (ULT) in many patients.AimTo identify all interventions that have attempted to improve the uptake of ULT and analyse the clinical outcomes.Design & settingA systematic review of international articles published in English.MethodA systematic search was conducted through MEDLINE, Embase, CINAHL Plus, and Scopus databases to identify all studies on relevant interventions for gout. Interventions were included if they aimed to address patient adherence with serum urate (SU) level as an outcome. This included patient education, practitioner monitoring, medication titration, SU monitoring, and ongoing patient engagement and follow-up. Follow-up studies to original interventions and those with only an abstract available were included.ResultsTwenty articles met the inclusion criteria, describing outcomes of 18 interventions conducted in primary care settings: six nurse-led, five pharmacist-led, and seven multidisciplinary, multifaceted interventions. Improvement in SU levels was observed in all interventions. Nurse-led interventions were effective at empowering patients as they addressed illness perceptions and provided education, advice, and telephone follow-up. Pharmacist-led interventions primarily aimed to monitor patients, alter medication dosage, and provide automated telephone follow-up. Various multifaceted programmes involving a range of providers resulted in increased sustained use of urate-lowering medication.ConclusionA nurse-led approach focusing on patient understanding about gout is the most effective in achieving improved patient adherence, and lowered SU levels among patients. An intervention should include patient education and follow-up components.

scholarly journals New recommendations of the American College of Rheumatology for the patient management with gout (2020). Review on some points

2021 ◽  
Vol 5 (2) ◽  
pp. 89-95
Author(s):  
M.A. Gromova ◽  
◽  
V.V. Tsurko ◽  
◽  
Keyword(s):  
Patient Management ◽  
Joint Damage ◽  
Dose Titration ◽  
Food Treatment ◽  
Management Algorithm ◽  
American College Of Rheumatology ◽  
Lowering Therapy ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Gout Flares

In May 2020, the updated recommendations of the American College of Rheumatology on the patient management with gout were published. The focus was on the indications for urate-lowering therapy (ULT) and its optimal use, treatment of gout flares, and the importance of lifestyle. A consensus based on current literature and patient preferences resulted in 42 recommendations. The sixteen highly recommended provisions included the following: ULT should be prescribed to all patients with tophi, radiological signs of joint damage or frequent gout flares; allopurinol should be preferred as a ULT first-line drug, including for patients with chronic kidney disease (CKD) above stage III; ULT regimen should begin at a low initial dose of allopurinol (<100 mg/day and below in CKD) or febuxostat (<40 mg/day); the treatment tactics should achieve the goal with dose titration under the control of the serum uric acid (SUA) level to maintain <6 mg/dL (<360 mmol/L). At the beginning of treatment, concomitant anti-inflammatory prophylactic therapy of at least 3–6 months was strongly recommended. Colchicine, nonsteroidal anti-inflammatory drugs or glucocorticoids (oral, intra-articular, or intramuscular) were suggested for the treatment of gout flares. The purpose of this publication was to inform physicians decision-making on the gout treatment about the patient management algorithm and the need to achieve the target level of SUA to prevent flares and complications of the disease. KEYWORDS: gout, hyperuricemia, clinical recommendations, urate-lowering therapy, diet, lifestyle, food, treatment. FOR CITATION: Gromova M.A., Tsurko V.V. New recommendations of the American College of Rheumatology for the patient management with gout (2020). Review on some points. Russian Medical Inquiry. 2021;5(2):89–95. DOI: 10.32364/2587-6821-2021-5-2-89-95.

scholarly journals Impact of urate-lowering therapy on quality of life indicators in patients with gout

2021 ◽  
Vol 15 (3) ◽  
pp. 62-68
Author(s):  
M. N. Chikina ◽  
O. V. Zhelyabina ◽  
M. S. Eliseev
Keyword(s):  
Quality Of Life ◽  
Physical Functioning ◽  
Bodily Pain ◽  
Well Being ◽  
Dose Titration ◽  
Role Physical ◽  
Lowering Therapy ◽  
General Physical

Gout can have a significant impact on the quality of life (QoL) of patients.Objective: to assess the dynamics of QoL indicators and the possibility of achieving the target level of uric acid (UA) in patients with gout on febuxostat therapy, with ineffectiveness and / or contraindications to the allopurinol administration.Patients and methods. The prospective, single-center study included 80 patients with gout. The follow-up period was at least 6 months of allopurinol or febuxostat (Azurix®) therapy in doses required to achieve the target UA level. When urate-lowering therapy was initiated, allopurinol 100 mg per day was prescribed, followed by dose titration (up to maximum of 900 mg per day) until the target UA level was reached (<360 μmol/L). Patients with ineffectiveness of allopurinol and / or adverse reactions (ADRs) were transferred to febuxostat 80–120 mg per day. To prevent arthritis attacks, all patients received low doses of non-steroidal anti-inflammatory drugs or colchicine 0.5 mg per day or glucocorticoids 7,5 mg per day (in prednisolone equivqlent). At the first and last visits, patients on febuxostat completed the SF-36 questionnaire.Results and discussion. After 6 months of follow-up, 70 (88%) patients received urate-lowering therapy, of whom 51 (73%) reached the target UA level. Allopurinol dosage titration required 26 patients, of whom 14 (54%) achieved the treatment goal. Due to the ineffectiveness of allopurinol, 32 patients were switched to febuxostat, which allowed to achieve normouricemia in 69% of cases. Fifteen (68%) of 22 patients who were initiated with febuxostat due to ADRs to allopurinol also achieved the target UA level. Patients who received febuxostat and reached the target UA level improved QoL indicators: role-physical functioning, bodily pain, general health, vitality and general physical well-being (p<0.05 in all cases). Patients who did not reach the target UA level on febuxostat therapy improved such indicators as physical functioning, role-physical functioning, and bodily pain (p<0.05 in all cases). High compliance was observed in 63% of patients, treated with febuxostat and in 36% of patients, treated with allopurinol.Conclusion. In patients with ineffectiveness or intolerance to allopurinol, in 69% of cases febuxostat allows to achieve the target UA level and improving QoL and complience.

scholarly journals Colchicine for acute arthritis attacks prevention in patients with gout during urate-lowering therapy (results of a pilot study)

2021 ◽  
Vol 15 (4) ◽  
pp. 50-55
Author(s):  
M. S. Eliseev ◽  
M. N. Chikina ◽  
O. V. Zhelyabina
Keyword(s):  
Complete Blood Count ◽  
Control Group ◽  
Lowering Therapy ◽  
Validated Questionnaire ◽  
Serum Creatine Phosphokinase ◽  
Maximum Pain ◽  
The Mean ◽  
Anti Inflammatory ◽  
Colchicine Therapy

Objective: to investigate the efficacy and safety of low-dose colchicine in patients with gout receiving urate-lowering therapy (ULT).Patients and methods. A single-center prospective study included 113 patients with gout. The main group consisted of 92 patients who were prescribed colchicine 0.5 mg/day combined with ULT (allopurinol or febuxostat), control group – 21 patients with contraindications to colchicine therapy who received only ULT. Patient data were entered into individual registration cards at the first visit, as well as on the 90th and 180th day after the start of drug intake. The presence of arthritis attacks was recorded by doctor or patient using a validated questionnaire. We compared the mean frequency of arthritis attacks in the groups, their duration and maximum pain intensity according to the visual analogue scale (VAS). Laboratory tests included: complete blood count test, general urinary test, uric acid (UA), blood glucose, alanine aminotransferase, aspartate aminotransferase, creatinine, serum creatine phosphokinase.Results and discussion. Patients who did not receive prophylactic anti-inflammatory therapy had significantly longer duration of the disease and higher number of affected joints. For 6 months of follow-up, there were no arthritis attacks in 54% of patients who were prescribed colchicine, and only in 19% of patients who did not use prophylactic anti-inflammatory therapy (p=0.004). The duration of arthritis attacks and the intensity of pain according to the VAS were also statistically significantly lower in the colchicine group (p<0.031 and p<0.01, respectively). Due to the development of adverse events, related to colchicine therapy, only 3 were excluded from the study. The mean serum UA level by the end of the study in colchicine group did not differ from that in the control group.Conclusion. Administration of colchicine, 0.5 mg/dai for 6 months after initiation of ULT is safe and can reduce the frequency and severity of arthritis attacks.

scholarly journals THU0423 ADHERENCE TO URATE-LOWERING THERAPY IN PATIENTS WITH SEVERE GOUT WHO RECEIVED СANAKINUMAB FOLLOWING A 5-YEAR RETROSPECTIVE ANALYSIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 449.1-450
Author(s):  
M. Elisеev ◽  
O. Sheliabina
Keyword(s):  
Interleukin 1 ◽  
Symptomatic Treatment ◽  
Symptomatic Therapy ◽  
Lowering Therapy ◽  
Long Term Follow Up ◽  
Inflammatory Drugs ◽  
Acute Attacks ◽  
Anti Inflammatory

Background:The adherence to lowering therapy for gout is low, including in chronic severe gout. Whether interleukin 1 inhibitors may contribute to better adherence is unknown.Objectives:To compare adherence to urate-lowering therapy in patients with severe gout who received canakinumab versus patients who received standard anti-inflammatory therapy (NSAIDs, glucorticoids, colchicine).Methods:Of the 513 patients with gout observed at the V.A. Nasonova Research Institute of Rheumatology, Moscow from 2013 to 2014 y 247 patients with the most severe gout, requiring regular symptomatic treatment, were selected. Of these, 25 patients (3 (12%) women and 22 (88%) men), the average age of 54.5 ± 12.7 g, received (at least 1) canakinumab injection of 150 mg subcutaneously as a symptomatic therapy, the remaining 222 patients (men) mean age 51.9 ± 11.4 g. received standard anti-inflammatory therapy (colchicine (55% of patients), glucorticoids (5%), NSAIDs (40%), or a combination of these (3%). On average, after 4,8 ± 1.7 years, a comparative analysis of adherence to reducing therapy was carried out, as well as the need for anti-inflammatory therapy and assessment of adherence according to the Score compliance on the scale of the Moriscy-Green patients who received and did not receive canakinumab.Results:Evaluation was available in 180 patients (16 who received canakinumab and 164 who received standard anti-inflammatory therapy) who were initially given reducible therapy. 11 patients died (2 patients (8%) who received canakinumab and 9 (4%) patients on standard anti-inflammatory therapy), 56 patients (7 (28%) and 49 (22%), respectively) were not available for observation. Adherence to urate-lowering therapy was better in patients who received canakinumab (see table 1).Table 1.Score compliance on the scale of the Moriscy-GreenAdherence to therapyPatients receiving canakinumab, (n %)Patients receiving standard anti-inflammatory therapy, (n %)р=High (> 4 points)14 (87)83 (51)0,07Moderate (3 points)2 (13)46 (28)0,13Low (2 and <points)035 (21)0,03The likelihood of maintaining the target uric acid level when taking urate-lowering drugs in patients who previously received canakinumab was higher (12 patients (75%) who received canakinumab and 32 (20%) patients received standard anti-inflammatory therapy (p = 0.005).During the year preceding the analysis, there were no acute attacks of arthritis in 12 (75%) patients who received canakinumab and 46 (28%) patients received standard anti-inflammatory therapy (p = 0.002).132 patients who previously received regular anti-inflammatory therapy and received standard anti-inflammatory therapy and 1 patient (1 attack) (p = 0.005) who previously received canakinumab took anti-inflammatory drugs over the past year due to the development of exacerbations (an average of 3 seizures per year): NSAIDs (54%) or colchicine (46%).Conclusion:Therapy with interleukin 1 Kanakinumab may contribute to a better adherence to lowering therapy and isidentified with a lesser need for symptomatic therapy with long-term follow-up.Disclosure of Interests: :Maxim Elisеev Speakers bureau: Novartis, Menarini Group, Alium, Olga Sheliabina: None declared

scholarly journals Predictors of loss to follow-up in art experienced patients in Nigeria: a 13 year review (2004–2017)

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Ahmad Aliyu ◽  
Babatunde Adelekan ◽  
Nifarta Andrew ◽  
Eunice Ekong ◽  
Stephen Dapiap ◽  
...  
Keyword(s):  
Patient Adherence ◽  
Cross Sectional Study ◽  
Emergency Plan ◽  
Cross Sectional ◽  
Loss To Follow Up ◽  
Viral Loads ◽  
Review Period ◽  
Lost To Follow Up ◽  
Differentiated Care

Abstract Background Expanded access to antiretroviral therapy (ART) leads to improved HIV/AIDS treatment outcomes in Nigeria, however, increasing rates of loss to follow-up among those on ART is threatening optimal standard achievement. Therefore, this retrospective cross-sectional study is aimed at identifying correlates and predictors of loss to follow-up in patients commencing ART in a large HIV program in Nigeria. Methods Records of all patients from 432 US CDC Presidents Emergency Plan for AIDS Relief (PEPFAR) supported facilities across 10 States and FCT who started ART from 2004 to 2017 were used for this study. Bivariate and multivariate analysis of the demographic and clinical parameters of all patients was conducted using STATA version 14 to determine correlates and predictors of loss to follow-up. Results Within the review period, 245,257 patients were ever enrolled on anti-retroviral therapy. 150,191 (61.2%) remained on treatment, 10,960 (4.5%) were transferred out to other facilities, 6926 (2.8%) died, 2139 (0.9%) self-terminated treatment and 75,041 (30.6%) had a loss to follow-up event captured. Males (OR: 1.16), Non-pregnant female (OR: 4.55), Patients on ≥ 3-monthly ARV refills (OR: 1.32), Patients with un-suppressed viral loads on ART (OR: 4.52), patients on adult 2nd line regimen (OR: 1.23) or pediatric on 1st line regimen (OR: 1.70) were significantly more likely to be lost to follow-up. Conclusion Despite increasing access to anti-retroviral therapy, loss to follow-up is still a challenge in the HIV program in Nigeria. Differentiated care approaches that will focus on males, non-pregnant females and paediatrics is encouraged. Reducing months of Anti-retroviral drug refill to less than 3 months is advocated for increased patient adherence.

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