Urate-lowering therapy for gout and asymptomatic hyperuricemia in the pediatric population: a cross-sectional study of a Japanese health insurance database View Full Text


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Article Info

DATE

2021-12-18

AUTHORS

Masataka Honda, Hideki Horiuchi, Tomoko Torii, Akihiro Nakajima, Takeshi Iijima, Hiroshi Murano, Hisashi Yamanaka, Shuichi Ito

ABSTRACT

BackgroundOur previous research showed that uric acid lowering therapy (ULT) for gout and hyperuricemia is being prescribed for pediatric patients even though these drugs have not been approved for use in children. However, the actual clinical situation has not been clearly elucidated. In this paper, we provide an in-depth look at the details of actual clinical practice.MethodsThis retrospective cross-sectional study accessed health insurance data for 696,277 children from April 2016 through March 2017 to identify pediatric patients with gout or asymptomatic hyperuricemia, calculate the proportion of patients prescribed ULTs, and analyze population characteristics. Adherence and mean dose for febuxostat and allopurinol, the most commonly prescribed drugs, were also analyzed.ResultsAmong children with gout or asymptomatic hyperuricemia, we found that 35.1% (97/276) were prescribed ULT. This proportion increased with age, especially among males. By comorbidity, ULT was prescribed to 47.9% (46/96) of patients with kidney disease, 41.3% (26/63) for cardiovascular disease, 40.0% (6/15) for Down syndrome, and 27.1% (32/118) for metabolic syndrome. In patients with kidney disease, febuxostat was prescribed more than twice as frequently as allopurinol (28 vs. 12). Median values for the medication possession ratio (MPR) of febuxostat and allopurinol were 70.1 and 76.7%, respectively, and prescriptions were continued for a relatively long period for both drugs. Both drugs were prescribed at about half the adult dose for patients 6–11 years old and about the same as the adult dose for patients 12–18 years old.ConclusionsThis study showed that the continuous management of serum uric acid is being explored using off-label use of ULT in pediatric patients with gout or asymptomatic hyperuricemia in Japan. Drug selection is based on patient characteristics such as sex, age, and comorbidities, and pediatric dosage is based on usage experience in adults. To develop appropriate pediatric ULT, clinical trials are needed on the efficacy and safety of ULT in the pediatric population.Trial registrationUMIN000036029. More... »

PAGES

581

Identifiers

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http://scigraph.springernature.com/pub.10.1186/s12887-021-03051-x

DOI

http://dx.doi.org/10.1186/s12887-021-03051-x

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1144004427

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/34922491


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29 schema:description BackgroundOur previous research showed that uric acid lowering therapy (ULT) for gout and hyperuricemia is being prescribed for pediatric patients even though these drugs have not been approved for use in children. However, the actual clinical situation has not been clearly elucidated. In this paper, we provide an in-depth look at the details of actual clinical practice.MethodsThis retrospective cross-sectional study accessed health insurance data for 696,277 children from April 2016 through March 2017 to identify pediatric patients with gout or asymptomatic hyperuricemia, calculate the proportion of patients prescribed ULTs, and analyze population characteristics. Adherence and mean dose for febuxostat and allopurinol, the most commonly prescribed drugs, were also analyzed.ResultsAmong children with gout or asymptomatic hyperuricemia, we found that 35.1% (97/276) were prescribed ULT. This proportion increased with age, especially among males. By comorbidity, ULT was prescribed to 47.9% (46/96) of patients with kidney disease, 41.3% (26/63) for cardiovascular disease, 40.0% (6/15) for Down syndrome, and 27.1% (32/118) for metabolic syndrome. In patients with kidney disease, febuxostat was prescribed more than twice as frequently as allopurinol (28 vs. 12). Median values for the medication possession ratio (MPR) of febuxostat and allopurinol were 70.1 and 76.7%, respectively, and prescriptions were continued for a relatively long period for both drugs. Both drugs were prescribed at about half the adult dose for patients 6–11 years old and about the same as the adult dose for patients 12–18 years old.ConclusionsThis study showed that the continuous management of serum uric acid is being explored using off-label use of ULT in pediatric patients with gout or asymptomatic hyperuricemia in Japan. Drug selection is based on patient characteristics such as sex, age, and comorbidities, and pediatric dosage is based on usage experience in adults. To develop appropriate pediatric ULT, clinical trials are needed on the efficacy and safety of ULT in the pediatric population.Trial registrationUMIN000036029.
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36 schema:keywords ConclusionsThis study
37 Down syndrome
38 Health Insurance Database
39 Japan
40 Japanese health insurance database
41 MethodsThis retrospective cross-sectional study
42 ResultsAmong children
43 ULT
44 acid
45 actual clinical practice
46 actual clinical situation
47 adherence
48 adult dose
49 adults
50 age
51 allopurinol
52 asymptomatic hyperuricemia
53 cardiovascular disease
54 characteristics
55 children
56 clinical practice
57 clinical situations
58 clinical trials
59 comorbidities
60 continuous management
61 cross-sectional study
62 data
63 database
64 depth look
65 detail
66 disease
67 dosage
68 dose
69 drug selection
70 drugs
71 efficacy
72 experience
73 febuxostat
74 gout
75 health insurance data
76 hyperuricemia
77 insurance data
78 insurance database
79 kidney disease
80 label use
81 long period
82 look
83 males
84 management
85 median value
86 medication possession ratio
87 metabolic syndrome
88 paper
89 patient characteristics
90 patients
91 patients 12
92 patients 6
93 pediatric dosages
94 pediatric patients
95 pediatric population
96 period
97 population
98 population characteristics
99 possession ratio
100 practice
101 prescription
102 previous research
103 proportion
104 proportion of patients
105 ratio
106 research
107 retrospective cross-sectional study
108 safety
109 selection
110 serum uric acid
111 sex
112 situation
113 study
114 syndrome
115 therapy
116 trials
117 urate-lowering therapy
118 uric acid
119 usage experience
120 use
121 values
122 years
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