Updates to Acute Gout and Peripheral Artery Disease

07 May Updates to Acute Gout and Peripheral Artery Disease

All TreatGx users now have access to the updated treatment algorithms for Acute Gout and Peripheral Artery Disease. As always, both of these updates include the TreatGx standard of providing personalized dosing based on pharmacogenetics, kidney function, liver function, and drug interactions.

Acute Gout 

This update accounted for revisions made to existing clinical guidelines as well as newer guidelines that will help guide safe and effective medication selection. These included the American College of Rheumatology 2020 Guideline [1] and the French Society of Rheumatology 2020 meta-analysis [2].

The selection of NSAID drugs will now include only the most routinely used medications to provide more personalized and efficient options. Guidance on duration of therapy is now provided based on gout guidelines.

Peripheral Artery Disease 

This update simplified the options offered and will focus on antithrombotic and symptomatic relief medications for peripheral artery disease (PAD). Dosing for hyperlipidemia treatment options such as statins, which are recommended for all PAD patients, can be referred to in the TreatGx Hyperlipidemia algorithm.

The option to use rivaroxaban + ASA in symptomatic lower extremity disease, and guidance on which patients may benefit the most from this intensified therapy was added based on the COMPASS trial and subgroups [3-5].

Risperidone CYP2D6 pharmacogenetics 

Pharmacogenetic recommendations from DPWG [6] have been added into TreatGx for risperidone (currently included in TreatGx for Anxiety – Post-Traumatic Stress Disorder, Bipolar 1 Disorder, Depression, and Schizophrenia), which will provide guidance for CYP2D6 ultrarapid or poor metabolizers.

References 

1. FitzGerald JD, Dalbeth N, Mikuls T, Brignardello-Petersen R, Guyatt G, Abeles AM, Gelber AC, Harrold LR, Khanna D, King C et al: 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis care & research 2020, 72(6):744-760.
2. Latourte A, Pascart T, Flipo RM, Chalès G, Coblentz-Baumann L, Cohen-Solal A, Ea HK, Grichy J, Letavernier E, Lioté F et al: 2020 Recommendations from the French Society of Rheumatology for the management of gout: Management of acute flares. Joint Bone Spine 2020, 87(5):387-393.
3. Eikelboom JW, Connolly SJ, Bosch J, Dagenais GR, Hart RG, Shestakovska O, Diaz R, Alings M, Lonn EM, Anand SS et al: Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. The New England journal of medicine 2017, 377(14):1319-1330.
4. Anand SS, Bosch J, Eikelboom JW, Connolly SJ, Diaz R, Widimsky P, Aboyans V, Alings M, Kakkar AK, Keltai K et al: Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet (London, England) 2018, 391(10117):219-229.
5. Kaplovitch E, Eikelboom JW, Dyal L, Aboyans V, Abola MT, Verhamme P, Avezum A, Fox KAA, Berkowitz SD, Bangdiwala SI et al: Rivaroxaban and Aspirin in Patients With Symptomatic Lower Extremity Peripheral Artery Disease: A Subanalysis of the COMPASS Randomized Clinical Trial. JAMA Cardiol 2021, 6(1):21-29.
6. DPWG. Dutch guidelines May 2020 update. https://api.pharmgkb.org/v1/download/file/attachment/DPWG_May_2020.pdf. Published 2020. Accessed April 16, 2021.