Unlocking the benefits of allopurinol: the role of timely initiation and adherence in cardiovascular and renal outcomes in hyperuricemia
Background: Increasing evidence links elevated serum uric acid levels to adverse cardiorenal outcomes. To date,
limited data exist on whether the benefits of urate-lowering therapies (ULTs) depend on timely treatment
initiation and sustained adherence in patients at high cardiovascular risk.
Methods: An economic evaluation was conducted, based on a simulation model populated by Italian real-world
patient-level data from the Uric Acid Right for Heart Health (URRAH) cohort to evaluate long-term cardiovascular,
renal, and economic outcomes associated with timely allopurinol use. 10,000 patients with hyperuricemia
(serum uric acid >5.6 mg/dL) and elevated cardiovascular risk were simulated over a 20-year time horizon.
Timely initiation of allopurinol (before the first gout flare) was compared with treatment initiated only after
symptomatic disease onset. Scenarios reflecting current and improved adherence to ULTs were assessed. Outcomes
included major adverse cardiovascular events, end-stage renal disease onset, and economic outcomes from
the payer’s perspective.
Results: According to our model, timely initiation of allopurinol was associated with modest but consistent health
gain (0.04 quality adjusted life years) including reductions in gout flares, cardiovascular- and renal endpoints.
Timely allopurinol initiation was cost-saving and, from a health economic perspective, dominant over current
practice. Improved ULT adherence amplified these benefits.
Conclusion: Our hypothesis-generating research suggests that, in hyperuricemic patients at high cardiovascular
risk, the potential benefits of allopurinol also depend on timely initiation and sustained adherence. While these
findings do not constitute evidence of causal clinical benefit, they support a broader cardiorenal clinical
approach to hyperuricemia management that extends beyond gout prevention
A Real-World Analysis of the Population with Hepatitis C Virus Infection Affected by Type 2 Diabetes in Italy: Patients’ Characteristics, Comorbidity Profiles and Treatment Patterns
Background and Objectives: HCV infection represents a main risk factor for type 2 diabetes (T2D). This real-world analysis investigated the HCV-positive (HCV+) population with a T2D co-diagnosis in Italy. Methods: From 2017 to 2021, HCV+ patients were identified from administrative databases and stratified into T2D-HCV+ and HCV+-only cohorts in the presence/absence of a T2D diagnosis. Both cohorts were further divided by treatment with direct-acting antivirals (DAAs). The subgroups were compared for demographic variables, comorbidity profiles, most frequent hospitalizations, and drug prescriptions before inclusion. A sensitivity analysis was performed on patients included after 2019, the year of widespread use of pangenotypic DAAs. Results: Considering HCV+ patients aged ≥55 years, T2D-HCV+ patients (N = 1277) were significantly (p < 0.001) older than HCV+-only (N = 6576) ones and burdened by a worse comorbidity profile (average Charlson index: 1.4 vs. 0.3, p < 0.05). Moreover, regardless of T2D presence, DAA-treated patients were older (p < 0.001) and had a worse Charlson index than the untreated ones. T2D-HCV+ patients showed tendentially higher hospitalization rates and co-medication prescriptions compared to the HCV+-only patients. After 2019, a trend towards reduced co-medication use in DAA-treated patients was noticed, especially antibiotics and cardiovascular drugs. Conclusions: The co-presence of T2D in HCV+ patients resulted in a worse clinical status, as confirmed by the more frequent requirement of hospitalizations and complex polypharmacy regimens
A real-world analysis of outcomes and healthcare costs of patients on perindopril/indapamide/amlodipine single-pill vs. multiple-pill combination in Italy
This analysis compared adherence, cardiovascular (CV) events and all-cause mortality incidence, and healthcare costs among hypertensive patients treated with perindopril (PER)/indapamide (IND)/amlodipine (AML) in single-pill combination (SPC) vs. multiple-pill combination, in a real-world setting in Italy. In this observational retrospective analysis of Italian administrative databases, adult patients treated with PER/IND/AML between 2010 and 2020 were… Read More »A real-world analysis of outcomes and healthcare costs of patients on perindopril/indapamide/amlodipine single-pill vs. multiple-pill combination in Italy
Hypertriglyceridemia is associated with decline of estimated Glomerular filtration rate and risk of end-stage kidney disease in a real-word Italian cohort: Evidence from the TG-RENAL Study
Background: This analysis investigated the role of hypertriglyceridemia on renal function decline and developmentof end-stage kidney disease (ESKD) in a real-world clinical setting.Methods: A retrospective analysis using administrative databases of 3 Italian Local Health Units was performedsearching patients with at least one plasma triglyceride (TG) measurement between 2013 and June 2020,followed-up until June 2021. Outcome… Read More »Hypertriglyceridemia is associated with decline of estimated Glomerular filtration rate and risk of end-stage kidney disease in a real-word Italian cohort: Evidence from the TG-RENAL Study