Chronic gout, estimated to affect 6.8 million U.S. adults, is a painful, inflammatory arthritis caused by high systemic levels of serum uric acid (sUA) resulting in hyperuricemia. Affected patients experience an intermittent pattern of acute flares, and disease management is aimed at providing short-term, immediate relief for acute flares and reducing the frequency of flares and the signs/symptoms of the disease using long-term urate-lowering therapy. Pharmacological treatment includes treatments for both acute attacks and chronic disease management; this report specifically examines the use of chronic gout treatments. Chronic gout treatment involves the use of urate-lowering drugs (ULDs) that prevent recurrent gout attacks by lowering the concentration of sUA to at least < 6="" mg/dl,="" or="" to="" a="" concentration="" that="" durably="" improves="" the="" signs/symptoms="" of="" gout,="" including="" palpable="" and="" visible="" tophi="" (often="">< 5="" mg/dl).="" leading="" ulds="" include="" xanthine="" oxidase="" inhibitors="" (xoi)="" (allopurinol="" [generics],="" takeda="" pharmaceutical’s="" uloric="" [febuxostat]),="" which="" prevent="" the="" synthesis="" of="" uric="" acid,="" and="" uricosuric="" drugs="" (probenecid="" [generics]),="" which="" increase="" the="" rate="" of="" excretion="" of="" uric="">

Using national patient-level claims data, Treatment Algorithms in Gout explores the use of key therapies and drug classes among newly diagnosed and recently treated gout patient populations. Among the newly diagnosed patients, we provide a quantitative analysis of percentage drug-treated and time to treatment, treatment patterns and share by line of therapy as well as progression between lines, recent patient share trends, and use of concomitant treatment. Among recently treated patients, we quantify a drug’s overall drug share, use in combination with other therapies, and source of business compared with its competitors, detailing which drugs precede others through an analysis of add-versus-switch patterns. Two additional claims database queries explore persistency and compliance by therapy.

Questions Answered in This Report:

  • Newly diagnosed patients: Less than half of newly diagnosed gout patients initiate pharmacotherapy with a chronic gout treatment within the first year of diagnosis. What percentage of these patients progress to a second- or third-line drug within the first year, and how quickly do patients progress? Which products capture the most patient share in the first, second, and third lines of treatment? How often is combination therapy used in each line of therapy?

  • Recently treated patients: In Q3 2014, the xanthine oxidase inhibitors dominated the gout treatment landscape. Which specific drugs garner the most patient share for recently treated gout patients? Have any therapies experienced market growth or decline over the key therapy periods studied?

  • Pathways to key therapies: Among patient share leaders for gout, allopurinol and Takeda Pharmaceutical’s Colcrys (colchicine) are the most likely treatments to precede other agents, consistent with these drugs’ leading position in early lines of therapy. How long does it take gout patients to progress to each key therapy? What are the various sources of business for each agent (i.e., new, add/switches, or continuing business)?

Scope:

Primary patient-level data: This report provides quantitative findings from our analysis of data covering approximately 40 million lives and provides the most representative sample of U.S. treatment practice for Medicare and commercially insured patients. This report is delivered as a key findings slide deck and a dashboard that can be accessed using the Internet, and presents claims that are between 6-12 months old at time of publication.

Patient Sample: Patients who are continuously enrolled for the complete two-year study period must meet the following condition: at least one claim with a diagnosis code for gout (International Classification of Diseases, Ninth Revision [ICD-9] diagnostic codes 274.0, 274.00, 274.01, 274.02, 274.03, 274.1, 274.10, 274.19, 274.8, 274.81, 274.82, 274.89) during the study period. Patients with a diagnosis code for familial Mediterranean fever (277.31) were excluded from the analysis. All patients must be aged 18 or older to qualify.

Newly diagnosed patients:

- Patient share by drug class and key products across three lines of therapy, within one year of diagnosis.

- Patient flowcharts through one year of treatment for all first-line products, including progression rates and add/switch behavior.

- Polypharmacy and key concomitant therapies by line of therapy.

- Quarterly trending of patient share by line of therapy.

Recently treated patients:

- Quarterly snapshot of patient share by drug class and key products.

- Pathway to key therapy flowcharts tracking the preceding therapy patterns for all key therapies, including add/switch behavior.

- Brand source of business including share for continuing, new (switches/adds), and new (initial therapy) business.

- Polypharmacy and key concomitant therapies.

- Quarterly trends in patient share for all key therapies.

Drug persistence (One year, all-brand).

Drug compliance (six-month medication possession ratio [MPR]).


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