Comparative effectiveness of allopurinol versus febuxostat for preventing incident renal disease in older adults: an analysis of Medicare claims data
Objective To assess the comparative effectiveness of allopurinol versus febuxostat for preventing incident renal disease in elderly. Methods In a retrospective cohort study using 2006-2012 Medicare claims data, we included patients newly treated with allopurinol or febuxostat (baseline period of 183 days without either medication). We used 5:1 propensity-matched Cox regression analyses to compare the HR of incident renal disease with allopurinol use (and dose) versus febuxostat (reference). Sensitivity analyses included multivariable-adjusted regression models. Results There were 31 465 new allopurinol or febuxostat treatment episodes in 26 443 patients; 8570 ended in incident renal disease. Crude rates of incident renal disease per 1000 person-years were 192 with allopurinol versus 338 with febuxostat. Crude rates of incident renal disease per 1000 person-years were lower with higher daily dose: allopurinol <200, 200-299 and ≥300 mg/day with 238, 176 and 155; and febuxostat 40 and 80 mg/day with 341 and 326, respectively. In propensity-matched analyses, compared with febuxostat, allopurinol use was associated with lower HR of incident renal disease, 0.61 (95% CI 0.49 to 0.77). Compared with febuxostat 40 mg/day, allopurinol doses <200, 200-299 and ≥300 mg/day were associated with lower HR of incident renal disease, 0.75 (95% CI 0.65 to 0.86), 0.61 (95% CI 0.52 to 0.73) and 0.48 (95% CI 0.41 to 0.55), respectively. Sensitivity analyses using multivariable-adjusted regression confirmed these findings. Conclusions Allopurinol was associated with a lower risk of incident renal disease in elderly patients than febuxostat. Future studies need to examine the mechanism of this potential renal benefit of allopurinol..
| Medienart: |
Artikel |
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| Erscheinungsjahr: |
2017 |
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| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:76 |
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| Enthalten in: |
Annals of the rheumatic diseases - 76(2017), 10, Seite 1669 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Cleveland, John D [VerfasserIn] |
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| Links: |
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| RVK: |
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| doi: |
10.1136/annrheumdis-2017-211210 |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Comparative effectiveness of allopurinol versus febuxostat for preventing incident renal disease in older adults: an analysis of Medicare claims data |
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| 520 | |a Objective To assess the comparative effectiveness of allopurinol versus febuxostat for preventing incident renal disease in elderly. Methods In a retrospective cohort study using 2006-2012 Medicare claims data, we included patients newly treated with allopurinol or febuxostat (baseline period of 183 days without either medication). We used 5:1 propensity-matched Cox regression analyses to compare the HR of incident renal disease with allopurinol use (and dose) versus febuxostat (reference). Sensitivity analyses included multivariable-adjusted regression models. Results There were 31 465 new allopurinol or febuxostat treatment episodes in 26 443 patients; 8570 ended in incident renal disease. Crude rates of incident renal disease per 1000 person-years were 192 with allopurinol versus 338 with febuxostat. Crude rates of incident renal disease per 1000 person-years were lower with higher daily dose: allopurinol <200, 200-299 and ≥300 mg/day with 238, 176 and 155; and febuxostat 40 and 80 mg/day with 341 and 326, respectively. In propensity-matched analyses, compared with febuxostat, allopurinol use was associated with lower HR of incident renal disease, 0.61 (95% CI 0.49 to 0.77). Compared with febuxostat 40 mg/day, allopurinol doses <200, 200-299 and ≥300 mg/day were associated with lower HR of incident renal disease, 0.75 (95% CI 0.65 to 0.86), 0.61 (95% CI 0.52 to 0.73) and 0.48 (95% CI 0.41 to 0.55), respectively. Sensitivity analyses using multivariable-adjusted regression confirmed these findings. Conclusions Allopurinol was associated with a lower risk of incident renal disease in elderly patients than febuxostat. Future studies need to examine the mechanism of this potential renal benefit of allopurinol. | ||
| 650 | 4 | |a Kidney diseases | |
| 650 | 4 | |a Dosage and administration | |
| 650 | 4 | |a Aged | |
| 650 | 4 | |a Allopurinol | |
| 650 | 4 | |a Prevention | |
| 650 | 4 | |a Health aspects | |
| 650 | 4 | |a Age | |
| 650 | 4 | |a Ethnicity | |
| 650 | 4 | |a Kidney transplantation | |
| 650 | 4 | |a Drug dosages | |
| 650 | 4 | |a Medicare | |
| 650 | 4 | |a Chronic illnesses | |
| 650 | 4 | |a Studies | |
| 650 | 4 | |a Comorbidity | |
| 650 | 4 | |a Cardiovascular disease | |
| 650 | 4 | |a Rheumatism | |
| 650 | 4 | |a Oxidative stress | |
| 650 | 4 | |a Arthritis | |
| 650 | 4 | |a Regression analysis | |
| 650 | 4 | |a Geriatrics | |
| 650 | 4 | |a Health risk assessment | |
| 650 | 4 | |a Beneficiaries | |
| 650 | 4 | |a Uric acid | |
| 650 | 4 | |a Hypertension | |
| 700 | 1 | |a Singh, Jasvinder A |4 oth | |
| 773 | 0 | 8 | |i Enthalten in |t Annals of the rheumatic diseases |d London : BMJ Publ. Group, 1939 |g 76(2017), 10, Seite 1669 |w (DE-627)129093912 |w (DE-600)7090-7 |w (DE-576)014429772 |x 0003-4967 |7 nnns |
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