CRYSTAL Trial: Efficacy and Safety of Lesinurad and Febuxostat in Tophaceous Gout

Achaia Taltoan, Mercer University College of Pharmacy

Tophaceous gout is a form of advanced gout characterized by persistent arthritis, white-yellow intradermal deposits, and frequent recurrent acute attacks. The 2012 American Rheumatology Association and the European League Against Rheumatism (EULAR) guidelines for gout recommend xanthine oxidase inhibitors, allopurinol, or febuxostat as first line treatment for chronic tophaceous gout with a goal serum urate <6 mg/dL. [1,2] The EULAR and American Rheumatology Association guidelines suggest a goal serum urate < 5 mg/dL for patients with severe gout symptoms, including tophi, chronic arthropathy, and frequent attacks. [2] Evidence shows that approximately 40% of patients treated with allopurinol achieve serum urate levels less than 6 mg/dL, and about 48% of febuxostat patients can maintain target serum urate levels for three consecutive months. [3,4]

Lesinurad is a novel selective urate anion absorption inhibitor approved for combination with a xanthine oxidase inhibitor for gout patients whose serum urate targets are not achieved with xanthine oxidase inhibitor monotherapy. The CLEAR 1 and CLEAR 2 trial assessed the use of lesinurad with allopurinol in patients who failed to meet serum urate goals with monotherapy. [5,6] However, no trial assessed the combination of febuxostat and lesinurad in patients who failed xanthine oxidase monotherapy, until the CRYSTAL trial was conducted. [7]

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Opioids vs. Non-Opioids in the Emergency Department for Acute Extremity Pain

Kayla Peltier, Mercer University College of Pharmacy

It is reported that almost two thirds of patients visiting emergency departments do so for treatment of pain. [1] The National Institute on Drug Abuse reports that each day more than 90 Americans die from an opioid overdose (including prescription pain relievers, heroin, and synthetic opioids). Furthermore, it is reported that 21%-29% of patients who are prescribed opioids for chronic pain misuse them, and 8%-12% of chronic pain patients develop an opioid use disorder. [2]

Therefore, this study aimed to compare the efficacy of various oral analgesics in addition to acetaminophen in an effort to determine if a combination of non-opioid analgesics could be a potential treatment option in the setting of acute extremity pain in the emergency department (ED). [3]

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