Racial/ethnic variation and risk factors for allopurinol-associated severe cutaneous adverse reactions: a cohort study.

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  • Additional Information
    • Source:
      Publisher: BMJ Country of Publication: England NLM ID: 0372355 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1468-2060 (Electronic) Linking ISSN: 00034967 NLM ISO Abbreviation: Ann Rheum Dis
    • Publication Information:
      Publication: London : BMJ
      Original Publication: London : H.K. Lewis
    • Subject Terms:
      Allopurinol/*adverse effects ; Drug Eruptions/*ethnology ; Gout Suppressants/*adverse effects; Adolescent ; Adult ; Black or African American/statistics & numerical data ; Aged ; Aged, 80 and over ; Allopurinol/administration & dosage ; Asian/statistics & numerical data ; Cohort Studies ; Databases, Factual ; Dose-Response Relationship, Drug ; Drug Eruptions/etiology ; Female ; Gout Suppressants/administration & dosage ; Hispanic or Latino/statistics & numerical data ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Native Hawaiian or Other Pacific Islander/statistics & numerical data ; Risk Factors ; United States/epidemiology ; Young Adult
    • Abstract:
      Objectives: To examine associations of race/ethnicity and purported risk factors with hospitalised allopurinol-associated severe cutaneous adverse reactions (AASCARs).
      Methods: We used US Medicaid data to identify incident allopurinol users between 1999 and 2012. We examined the risk of hospitalised AASCARs according to race/ethnicity and purported key risk factors and calculated relative risks (RR).
      Results: Among 400 401 allopurinol initiators, we documented 203 hospitalised AASCAR cases (1 in 1972 initiators). The average AASCAR hospitalisation was 9.6 days and 43 individuals (21%) died. The multivariable-adjusted RRs for AASCARs among blacks, Asians and Native Hawaiians/Pacific Islanders compared with whites or Hispanics were 3.00 (95% CI 2.18 to 4.14), 3.03 (95% CI 1.72 to 5.34) and 6.68 (95% CI 4.37 to 10.22), respectively. Female sex, older age (≥60 years), chronic kidney disease and initial allopurinol dose (>100 mg/day) were independently associated with a 2.5-fold, 1.7-fold, 2.3-fold and 1.9-fold higher risk of AASCAR, respectively. In our combined demographic analysis, older women (≥60 years) of a high-risk race/ethnicity (blacks, Asians or Native Hawaiians/Pacific Islanders) had over a 12-fold higher risk of hospitalised AASCARs than younger men of a low-risk race/ethnicity (whites or Hispanics) (multivariable-adjusted RR, 12.25; 95% CI 6.46 to 23.25).
      Conclusions: This racially diverse (yet mostly white) cohort study indicates that the risk of hospitalised AASCAR is rare overall, although blacks, Asians and Native Hawaiians/Pacific-Islanders have a substantially higher risk of hospitalised AASCARs, particularly among older women. These data also support the practice of initiating allopurinol at a low dose (eg, ≤100 mg/day).
      Competing Interests: Competing interests: HKC has received research grants from Pfizer and Astra-Zeneca to Massachusetts General Hospital for unrelated studies and served as a consultant for Takeda Pharmaceuticals, Selecta, Horizon and Ironwood. SCK has received research grants to the Brigham and Women’s Hospital from Pfizer, AstraZeneca, Bristol-Myers Squibb and Roche for unrelated studies.
      (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
    • Comments:
      Comment in: Ann Transl Med. 2018 Nov;6(Suppl 1):S7. (PMID: 30613583)
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    • Grant Information:
      R01 AR065944 United States AR NIAMS NIH HHS; T32 AR007258 United States AR NIAMS NIH HHS
    • Contributed Indexing:
      Keywords: epidemiology; gout; health services research
    • Accession Number:
      0 (Gout Suppressants)
      63CZ7GJN5I (Allopurinol)
    • Publication Date:
      Date Created: 20180415 Date Completed: 20190805 Latest Revision: 20221207
    • Publication Date:
      20240829
    • Accession Number:
      PMC6045437
    • Accession Number:
      10.1136/annrheumdis-2017-212905
    • Accession Number:
      29653927