Many US rheumatologists fail to follow ACR gout guidelines for urate lowering drug dosage
Key takeaways:
- A survey of rheumatologists showed overall good adherence to ACR guidelines for gout management.
- Less than 50% reported following initial recommended dosages for allopurinol or febuxostat.
Rheumatologists report largely adhering to American College of Rheumatology guidelines for gout management, but show notable divergence with the recommended dosages of urate-lowering therapies, according to survey data.
“The management of gout remains suboptimal because of the lack of adherence to treatment recommendations by health care providers, patients’ poor understanding of the disease and its management or both,” Naomi Schlesinger, MD, of the division of rheumatology at the University of Utah’s Spencer Fox Eccles School of Medicine, and colleagues wrote in The Journal of Rheumatology.
“In June 2020, the ACR published an updated guideline, reinforcing many of the 2012 recommendations and including patient preferences and consideration of costs,” they added. “To date, no comprehensive studies to our knowledge have been published on physicians’ knowledge of and stated adherence to the 2020 ACR Guideline for the Management of Gout.”
For a glimpse at how rheumatologists think about and use the ACR guidelines, Schlesinger and colleagues surveyed 201 U.S. rheumatologists with a 57-item questionnaire. The survey gauged their adherence to 15 different recommendations, yielding a score of up to 15. It also asked how much rheumatologists agreed with of the 14 recommendations using a seven-point Likert scale, yielding a total agreement score of up to 14.
The rheumatologists were identified through the digital networking platform Serno and compensated for their participation. Their average age was 50.2 years, about 70% were in private practice, and 54% had more than 15 years of practice experience.
According to the researchers, the mean adherence score was 11.5, and the mean agreement score was 7.7. Mean adherence scores were higher among rheumatologists with 8 or fewer years of experience (12.3) vs. those with more experience (11.3), as well as those who reported seeing 75 or fewer patients with gout every 6 months (12.1) vs. those who claimed to see more (11.2).
Approximately 78% of rheumatologists reported following the ACR’s strong recommendation to initiate urate-lowering therapy for certain patients, and 89% said their likely first-line prescription for all patient types would be allopurinol, as recommended by ACR.
However, adherence to recommended starting dosages was lower, with just 43% reporting that they start allopurinol at 100 mg per day or below, and 39% claiming to start febuxostat at 40 mg per day or below. The results suggest that “rheumatologists rely more on their experience to determine the appropriate dosing for patients and that they may vary dosing based on the patient type and comorbidities,” Schlesinger and colleagues wrote.
“The survey results indicate that rheumatologists have good awareness of the recommendations in the 2020 ACR Guideline for the Management of Gout,” they added. “The results also highlight the discordance between their reported practice and some recommendations, specifically regarding the treatment dosing regimens... Addressing these gaps could improve the quality of patient care.”
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