Can racial disparities in optimal gout treatment be reduced? evidence from a randomized trial
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COMMENTARY
Open Access
Can racial disparities in optimal gout treatment be reduced? Evidence from a randomized trial Jasvinder A Singh1,2,3,4,5
Abstract There is a disproportionate burden of gout in AfricanAmericans in the U.S. due to a higher disease prevalence and lower likelihood of receiving uratelowering therapy (ULT), compared to Caucasians. There is an absence of strong data as to whether the response to ULT differs by race/ethnicity. BMC Musculoskeletal Disorders recently published a secondary analyses of the CONFIRMS trial, a large randomized controlled, doubleblind trial of 2,269 gout patients. The authors reported that the likelihood of achieving the primary study efficacy end-point of achieving serum urate < 6 mg/dl was similar between African-Americans and Caucasians, for all three treatment arms (Febuxostat 40 mg and 80 mg and allopurinol 300/200 mg). More importantly, rates were similar in subgroups of patients with mild or moderate renal insufficiency. Adverse event rates were similar, as were the rates of gout flares. These findings constitute a convincing evidence to pursue aggressive ULT in gout patients, regardless of race/ethnicity. This approach will likely help to narrow the documented racial disparities in gout care. Please see related article: http://www.biomedcentral. com/1471-2474/13/15 Keywords: Gout, Disparity, Race, treatment, Febuxostat, Allopurinol, randomized, African-American
Background Gout is the most common inflammatory arthritis in the U.S. that affects 4% of the general U.S. population [1]. The prevalence of gout is increasing in the U.S. [1-3], related at least partially to a rising rates of obesity and hypertension [1]. Based on the National Health and Nutrition Examination Survey (NHANES) 2007-2008, it Correspondence: [email protected] 1 Medicine Service, Birmingham VA Medical Center and Department of Medicine, University of Alabama, Birmingham, AL, USA Full list of author information is available at the end of the article
is estimated that 6 million Caucasians and 1.2 million African-Americans in the U.S. have gout [1]. Gout presents with an extremely painful intermittent inflammatory arthritis, which over time, progresses to a chronic, deforming arthritis similar to rheumatoid arthritis. In addition to causing musculoskeletal morbidity and urate kidney stones, gout is an independent risk factor for cardiovascular morbidity and mortality [4-7]. The treatment of gout includes two approaches, treatment of acute episodes with medications that are antiinflammatory including non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or corticosteroids (oral, systemic or intra-articular) and the long-term treatment of hyperuricemia with medications that either reduce the production of uric acid (urate-lowering therapy (ULT) with xanthine oxidase inhibitors, allopurinol or febuxostat) or increase the excretion of urate (uricosurics such as probenecid [available in U.S.]; benzbromarone and sulfinpyrazone [not available in U.S.]) [8]. Due to a higher efficacy regardless o
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