Prescribing patterns of allopurinol and febuxostat according to directives on the reimbursement criteria and clinical guidelines: analysis of a primary care database

AbstractObjective: According to American clinical guidelines, allopurinoland febuxostatmay be prescribed as first-line therapy to treat hyperuricemia. However, the Italian Medicines Agency directive, called Nota 91, allows the reimbursement of second-line febuxostatin the case of failure and/or intolerance of a previous allopurinoltherapy, so partially embracing European League Against Rheumatism recommendations and the British Society for RheumatologyGuideline. Such inconsistency might lead to heterogeneity among General Practitioners (GPs) in treatment of hyperuricemia. This study, therefore, aimed to evaluate the prescribing behavior of GPs in terms of compliance with Nota 91 and/or official guidelines.Methods: Using the Health Search Database, a retrospective cohort studywas conducted to evaluate the patterns of use of allopurinoland febuxostatbetween 2011 and 2016.Results: In total, 44,257 and 5837 patients were prescribed with allopurinoland febuxostat, respectively. Among febuxostatusers,...