Two years after its listing for second-line treatment in gout, a PBS review has found that febuxostat is being used less than expected.
In a predicted versus actual utilisation audit for febuxostat in the treatment of chronic gout, the Drug Utilisation Sub-Committee (DUSC) has found that the number of patients supplied febuxostat was 2,421 in the first year and 4,881 in the second year of its PBS listing.
While the number of prescriptions continued to increase, the DUSC concluded that “substantially fewer patients were supplied febuxostat than predicted.”
Its report postulated that recent cardiovascular safety concerns might have deterred its use.
Despite the lower-than-expected usage of febuxostat, the DUSC did not consider this grounds to ease restrictions on prescribing. It noted that in July 2017 the PBAC had rejected a request from sponsor Menarini to have the PBS restriction on the febuxostat eased from Authority Required (telephone) to Authority Required (STREAMLINED).
“The PBAC rejected the request as the restriction appeared to be appropriately targeting therapy to the right people, and there remained a risk that people with allopurinol insufficiency would be prescribed febuxostat although there was a lack of evidence of efficacy and safety in these people,” the review said.
“Considering the PBAC outcome, the utilisation data and the safety signals, DUSC considered it would be appropriate for the restriction to remain as Authority Required.
When febuxostat was recommended for listing on the PBS in 2015, the PBAC specified it should be for second line use, and expressed concern there may be ‘leakage’ to first line use in patients with chronic gout who had not tried allopurinol.
“The PBAC considered the proposed use of febuxostat as an alternative second-line treatment to be reasonable but was unsure whether in practice, febuxostat use would be limited to the secondline setting. The PBAC considered it possible that some febuxostat use would occur in the first-line setting,” it said in the summary of its March 2015 meeting.