Ders recently published a secondary analyses of the CONFIRMS trial, a
Ders 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/Keywords: Gout, Disparity, Race, treatment, Febuxostat, Allopurinol, randomized, African-AmericanBackground 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, itCorrespondence: [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 articleAfrican-Americans have a higher prevalence of gout compared to Caucasians, ranging from 2-fold higher in an earlier study [16] to 1.25-fold higher in a recent analyses of NHANES 2007-08 [1]. An analysis of the 2002 US National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey found that African-Americans with gout were less likely to receive ULT compared to Caucasians [17]. The Institute of Medicine has identified that racial disparities in health care are common and that they are unacceptable [18]. Specifically,?2012 Singh; licensee BioMed Central Ltd. This is PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/28250575 an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and Ornipressin cost reproduction in any medium, provided the original work is properly cited.Singh BMC Medicine 2012, 10:15 http://www.biomedcentral.com/1741-7015/10/Page 2 ofAfrican Americans and Hispanics tend to receive lower quality of healthcare across a range of chronic conditions, and these disparities are found across a range of clinical settings, such as public and private hospitals. The report suggested multifaceted approach to reducing and eliminating these disparities, including raising public and health care professionals’ awareness of the problem, health system interventions such as following published guidelines and improving health care access, educational tools for patients to improve participation in their care and decision-making and policy and regulatory strategies. The higher prevalence of gout coupled with lower likelihood of receiving ULT leads to a disproportionate morbidity of gout in African-Americans in the U.S. It is not known to what extent underutilization of ULT in African-Americans with gout is due to socioeconomic factors, health care insurance and access, distance to the nearest health care facility, patient preference, health literacy or health ca.