Comparative effectiveness of allopurinol versus ...

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Jun 5, 2017 - AbstrACt. Objective to assess the comparative effectiveness of allopurinol versus febuxostat for preventing incident renal disease in elderly.
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ARD Online First, published on July 13, 2017 as 10.1136/annrheumdis-2017-211210 Clinical and epidemiological research

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Comparative effectiveness of allopurinol versus febuxostat for preventing incident renal disease in older adults: an analysis of Medicare claims data Jasvinder A Singh,1,2,3 John D Cleveland2 1

Medicine Service, VA Medical Center, Birmingham, Alabama, USA 2 Department of Medicine at School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA 3 Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA Correspondence to Dr Jasvinder A Singh, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294-0022, USA; j​ asvinder.​md@g​ mail.​com Received 26 January 2017 Revised 24 April 2017 Accepted 30 April 2017

Abstract 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