Prevalence of contraindications and prescription of pharmacologic therapies for gout |
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Authors: | Keenan Robert T O'Brien William R Lee Kristen H Crittenden Daria B Fisher Mark C Goldfarb David S Krasnokutsky Svetlana Oh Cheongeun Pillinger Michael H |
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Affiliation: | aSection of Rheumatology, New York Campus of the US Department of Veterans Affairs, New York;cSection of Nephrology of the New York Harbor Health Care System, New York Campus of the US Department of Veterans Affairs, New York;bDivision of Rheumatology, New York University School of Medicine, New York;dDivision of Nephrology, New York University School of Medicine, New York;eDivision of Biostastics, New York University School of Medicine, New York |
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Abstract: | BackgroundPatients with gout have comorbidities, but the impact of these comorbidities on treatment has not been studied.MethodsA 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.ResultsThe 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).ConclusionPatients 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. |
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Keywords: | Comorbidity Drug contraindication Gout Quality of care Treatment |
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