P149 Prescription for consultations with gout flare in primary care: an observational study
Authors: Padmanabhan Nishita , Muller Sara , Mallen Christian , Roddy Edward 
Published: April 2022

Abstract

Background/Aims
Gout flares are severely painful and managed with non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or corticosteroids. NSAIDs are used most commonly, yet many patients with gout have contraindications such as chronic kidney disease (CKD). We investigated the medications prescribed for gout flares in primary care, how these differed according to CKD, colchicine dosing, and prescription trends over time between 2005 and 2015.

Methods
Using the Consultations in Primary Care Archive, an electronic health record database from thirteen general practices in North Staffordshire, we identified all consultations for a gout flare. Prescriptions for NSAIDs, colchicine and prednisolone were identified. We calculated the proportion of consultations resulting in a prescription for NSAIDs, colchicine and corticosteroids, overall and stratified by eGFR (≥60, &lt;60 ml/min/1.73m2). We examined which NSAIDs and which colchicine doses were prescribed. The trends in prescriptions of NSAID, colchicine or oral prednisolone prescriptions from 2005 to 2015 were described.

Results
We identified 2641 people with a diagnosis of gout and 1308 consultations for gout flares. The mean (SD) age at flare consultation was 62.6 (14.9) years, and 1025 (78.4%) were male. Flare consultations resulted in 408 (31.2%) NSAID, 294 (22.5%) colchicine, 9 (0.7%) prednisolone prescriptions. We found that 619 (47.3%) did not have a prescription. 21 (1.6%) received a prescription for more than one drug class (colchicine and either NSAID or prednisolone). eGFR was recorded as &lt; 60ml/min/1.73m2 in 224 (17.1%) of the sample. Colchicine doses prescribed were 500mcg 1-2 times/day in 84 (28.6%), 500mcg 3-4 times/day in 112 (38.1%), 500mcg 6-8 times/day in 49 (16.7%) and as directed in 49 (16.7%) consultations. Diclofenac was the most commonly prescribed NSAID (n = 143, 35.1%), followed by naproxen (n = 106, 26.0%) and indomethacin (n = 93, 22.8%). Colchicine (n = 65, 29.0%) was the most common treatment choice in individuals with eGFR&lt;60 and NSAIDs (n = 372, 34.3%) in those with ≥60ml/min/1.73m2. Over time, the proportion of patients prescribed colchicine rose from 15.5% in 2005 to 31.2% in 2015, whereas NSAID prescriptions declined from 38.1% in 2005 to 15.0% in 2015.

Conclusion
Gout flares were most commonly treated with NSAIDs, except in individuals with CKD, where colchicine was most common. Over time, colchicine prescriptions have become more common, whereas NSAID prescriptions have declined.

Disclosure
N. Padmanabhan: Grants/research support; N.P. is an NIHR Academic Clinical Fellow. S. Muller: Grants/research support; S.M. is part-funded by the NIHR Applied Research Collaboration West Midlands (ARC WM). C. Mallen: Grants/research support; C.D.M. is part-funded by the NIHR Applied Research Collaboration West Midlands (ARC WM), C.D.M. is funded by the NIHR School for Primary Care Research and a NIHR Research Professorship in General Practice. E. Roddy: None.