Dosage individualization proposed for anti-gout medications among the patients with gout: a bicentric study in Nepal
Authors: Sapkota Binaya , Chaudhary Suraj , Gurung Prakash , Humagain Anisha , Sapkota Sujan 
Published: December 2020

Background

The conventional one-size-fits-all approach has been criticized for almost all drugs used especially for chronic diseases, including gout. The present study was aimed to individualize and optimize the dose of anti-gout medications among gout patients.

Methods and findings

Bicentric cross-sectional study was carried out among 384 randomly selected new gout patients visiting two gout treatment centers at Lalitpur Metropolitan City, Nepal and taking antigout medications. Patients not taking anti-gout medications and not showing unwillingness to participate were excluded. The eGFR was calculated with the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation (2009). Doses to be individualized were decided based on the Renal Drug Handbook and BNF 80. Data were analyzed via R 4.0.3. Multinomial logistic regression analysis was performed to analyze statistical significance of risk with various predictors, considering a p-value <0.05 statistically significant. Comorbidities were coded as per the ICD-11 coding and ATC classification of medicines as per the WHO Guidelines for ATC classification and DDD assignment 2020. High risk of progression to CKD increased in the age range 54-63 and ≥84 years by 17.77 and 43.02 times, respectively. High risk of gout increased by 29.83 and 20.2 times for overweight and obese patients respectively. Aceclofenac 100 mg was prescribed for maximum patients (117, 30.5%). Need of dose individualization was realized altogether in case of 30 patients (8%), with maximum (7, 1.8%) in case of etoricoxib 90 mg (i.e., avoid if possible). There were 260 (67.7%) cases without associated comorbidities, followed by 37 (9.6%) patients with hyperthyroidism. Various glucocorticoids were prescribed for 141 (36.9%) patients, out of whom 14 (3.8%) required dose individualization. Altogether 61 (15.9%) patients were prescribed with xanthine oxidase inhibitors, out of whom 5 (1.3%) required dose individualization.

Conclusions

Thirty (8%) cases required dose individualization, which was although minimal but could have meaningful impact on clinical success of individual patient. Based on the recommendation on dose individualization, those patients could be optimized on their therapy on future follow ups. Also, future randomized controlled trials may be based on these to derive a more conclusive evidence base for gout management.

Author summary

Why was this study done?

Dosage individualization helps optimize drug selection and dosing based on pathogenesis, mechanism of action of drugs, and their dose exposure-response relationships.

Very limited researches have been undertaken in Nepal to individualize medications for chronic medication users including gout patients. The present study was probably the first of its kind in Nepal aiming to individualize the dose of anti-gout medications among gout patients.

What did the researchers do and find?

Bicentric cross-sectional study was carried out among 384 new gout patients visiting two gout treatment centers in Nepal and taking antigout medications.

Doses to be individualized were decided based on standard references of the Renal Drug Handbook and the British National Formulary 80. Dose to be individualized was later discussed with the prescribing physicians.

Need of dose individualization was realized altogether in case of 30 patients (8%), with maximum (7, 1.8%) in case of etoricoxib 90 mg (i.e., avoid if possible).

What do these findings mean?

The present simple effort of individualization of antigout medications might help the physicians optimize the therapeutic success for the patients, once they implement it and patients adhere to it.

Since the study was limited to only two gout and rheumatic diseases treatment centers, it might not represent the whole gout patients in the nation but it might provide the evidence base for future large controlled clinical trials.