Chronic Gout and Prevention of NSAID-Induced Gastrotoxicity

All TreatGx users now have access to the updated algorithms for Chronic Gout and Prevention of Non-Steroidal Anti-Inflammatory (NSAID)-Induced Gastrotoxicity. 

Chronic Gout: 

This comprehensive update incorporates information from the most recent clinical guidelines and literature, including updates from the American College of Rheumatology [1], BMJ Best Practice [2], and the European League Against Rheumatism [3].  

New information about pharmacogenetic testing for select populations before starting allopurinol are included, based on the latest evidence-based recommendations from the 2020 American College of Rheumatology Guideline for the Management of Gout. Four additional NSAID options for anti-inflammatory prophylaxis have also been added to give clinicians a broad range of medications to select from, based on patient specific factors. 

In addition to the TreatGx standard of providing personalized dosing based on pharmacogenetics, kidney function, liver function, and drug interactions, the Chronic Gout update includes informative notes on dose administration considerations, co-morbid conditions, and duration of treatment.  

 Prevention of NSAID-Induced Gastrotoxicity: 

This update includes a review of recent guidelines and literature, notably the 2018 International Consensus on NSAID-Induced Gastropathy [4], a 2018 meta-analysis by Scally et al. [5], and a 2016 review by Melcarne et al [6]. 

Dexlansoprazole has been added as an option with proton pump inhibitors (PPIs). Based on the 2020 CPIC Guideline for CYP2C19 and PPI Dosing [7], guidance based on CYP2C19 metabolizer status has been added to TreatGx for dexlansoprazole (optional CPIC recommendations). After reviewing the safety of off-label dosing, nizatidine has been removed from treatment options. 

In addition to the TreatGx standard of providing personalized dosing based on pharmacogenetics, kidney function, liver function, and drug interactions, the Prevention of NSAID-Induced Gastrotoxicity update includes informative notes on the efficacy and tolerability of second-line options. 

 References: 

1. FitzGerald JD, Dalbeth N, Mikuls T, Brignardello-Petersen R, Guyatt G, Abeles AM, Gelber AC, Harrold LR, Khanna D, King Cet al:2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis & rheumatology (Hoboken, NJ) 2020, 72(6):879-895. 
2. Badlissi F:Gout.BMJ Best Practice 2020. 
3. Richette P, Doherty M, Pascual E, Barskova V, Becce F:2016 updated EULAR evidence-based recommendations for the management of gout. 2017,76(1):29-42. 
4. Hunt R, L BL, Y CM, Manuc M, Gn R, K SA, D SB, N VB, B SI, A AKet al:International Consensus on Guiding Recommendations for Management of Patients with Nonsteroidal Antiinflammatory Drugs Induced Gastropathy-ICON-G. Euroasian J Hepatogastroenterol 2018, 8(2):148-160. 
5. Scally B, Emberson JR, Spata E, Reith C, Davies K, Halls H, Holland L, Wilson K, Bhala N, Hawkey Cet al:Effects of gastroprotectant drugs for the prevention and treatment of peptic ulcer disease and its complications: a meta-analysis of randomised trials. Lancet Gastroenterol Hepatol 2018, 3(4):231-241. 
6. Melcarne L, García-Iglesias P, Calvet X:Management of NSAID-associated peptic ulcer disease.Expert review of gastroenterology & hepatology 2016, 10(6):723-733. 
7. Lima JJ, Thomas CD, Barbarino J, Desta Z, Van Driest SL, El Rouby N, Johnson JA, Cavallari LH, Shakhnovich V, Thacker DLet al:Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C19 and Proton Pump Inhibitor Dosing. Clin Pharmacol Ther 2020.