Prescription for consultations with gout flare in primary care

Conference:

2021 SAPC North (virtual)

Talk Code:

1B.6

Presenter:

N Padmanabhan

Co-authors:

Padmanabhan N1,2, Muller S1, Mallen C1, 3, Roddy E1,3

Author institutions:

1 – School of Medicine, Keele University, Newcastle-under-Lyme 2 – University Hospitals of North Midlands NHS Trust, Stoke-on-Trent 3 – Midlands Partnership NHS Foundation Trust, Stoke-on-Trent

Introduction:

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). Using a regional primary care database, we investigated the medications prescribed for gout flares, how these differed according to CKD, colchicine dosing, and prescription trends 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. We identified the proportion of consultations resulting in a prescription for NSAIDs, colchicine and corticosteroids, overall and stratified by eGFR (≥60, <60ml/min/1.73m2). We examined which NSAIDs and which colchicine doses were prescribed and how prescriptions changed over time.

Results:

We identified 2641 people with a diagnosis of gout and 1308 consultations for gout flare. The mean (SD) age at flare consultation was 62.6 (14.9) years, and 1025 (78.4%) were male. Flare consultations resulted in 361 (27.6%) NSAID, 260 (19.9%) colchicine, 13 (1.0%) prednisolone prescriptions. We found that 674 (51.5%) did not have a prescription. Colchicine doses prescribed were 500mcg 1-2 times/day in 88 (33.9%), 500mcg 3-4 times/day in 92 (35.4%) and 500mcg 6-8 times/day in 43 (16.5%) consultations. Diclofenac was the most commonly prescribed NSAID (n=128, 35.5%), followed by naproxen (n=86, 23.8%) and indomethacin (n=85, 23.6%). Colchicine (n=76, 25.3%) and NSAIDs (n=322, 31.9%) were the most common treatment choice in individuals with eGFR<60 and ≥60ml/min/1.73m2 respectively. Over time, the proportion of patients prescribed colchicine rose from 18.3% in 2005 to 60% in 2015, whereas NSAID prescriptions declined from 61.5% in 2005 to 24% in 2015.

Conclusions

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

Funding acknowledgement:

Nishita Padmanabhan is an National Institute for Health Research (NIHR) Academic Clinical Fellow. Christian Mallen is funded by the National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands and the National Institute for Health Research (NIHR) School for Primary Care Research. The views expressed are those of the author(s) and not necessarily those of the (partner organisation), the NHS, the NIHR or the Department of Health and Social Care.