Study to compare gout treatments

A gout epidemic is sweeping the U.S.

Four percent of the U.S. population has gout, and the number is going up rapidly. It has become the most common form of inflammatory arthritis in adults. It is also associated with significant morbidity and mortality in older men and magnified in patients with chronic kidney disease (CKD).

James O’Dell, M.D., Bruce professor and chief of the UNMC Division of Rheumatology and Immunology, is the principal investigator on a four-year, $23 million VA Cooperative Study titled “Comparative Effectiveness in Gout: Allopurinol vs. Febuxostat.”

The study will include 950 patients from contracted sites around the country, including UNMC, various VA sites and various Rheumatoid Arthritis Investigational Network (RAIN) sites. Because gout is common in the demographic of the VA patient population, this study could lead to significantly improved patient outcomes.

Documentation shows gout is the most mismanaged chronic disease there is, Dr. O’Dell said. Ninety percent of patients with gout have problems with chronic gout. This number should be less than 10 percent if properly managed.
“The prevalence of gout in patients with renal failure is upwards of 30 percent,” Dr. O’Dell said. “Our study will be the first time that a substantial number of patients with kidney disease, who have gout, will be studied.”

According to the proposal, two drugs have been endorsed as first-line treatment for gout, allopurinol and febuxostat. Both drugs are effective and generally well-tolerated, but febuxostat costs considerably more. However, according to a previous survey of 179 VA practitioners, febuxostat appears to be the drug of choice. The reasoning seems to be the perception that febuxostat provided superior efficacy and tolerability.

This study will compare the two therapies for lowering uric acid levels to see which is the most clinically and economically effective, Dr. O’Dell said.