Allopurinol Prescription Patterns among Patients Attending Primary Health Care Centers in Qatar: A Retrospective Cross-Sectional Study

Introduction: Hyperuricemia is a medical condition associated with an increased incidence of comorbidities. Guidelines for the treatment of asymptomatic hyperuricemia remain controversial. Several studies have reported that allopurinol is overused worldwide. In Qatar, no national guidelines for hyperuricemia management or previous studies have evaluated allopurinol over prescription. The study aimed to determine the frequency of allopurinol overtreatment and investigate the associated factors. Methods: The retrospective cross-sectional study was conducted in Qatar on adult patients who were prescribed allopurinol for the first time at the Primary Health Care Corporation between 01 July 2021 and June 30, 2022. Data were extracted from patients' electronic medical records. Appropriate use of allopurinol was defined as for the presence of gout, kidney stones, or kidney disease, evidence of tophi, extremely high serum uric acid levels (>773.24 mmol/L in men or >594.8 mmol/L in women), or ongoing chemotherapy for malignancy in asymptomatic patients. Results: Our study included 1949 patients who received their first allopurinol prescription. The mean age was 45.66 years (standard deviation=10.57), with male predominance (75%). Only 17.39% were natives of Qatar, while the remaining were expatriates. The top three comorbidities were hypertension, dyslipidemia, and diabetes (44.38%, 42.74%, and 30.17%, respectively). Seventeen patients had no associated diagnosis with allopurinol prescriptions. Most patients had diagnoses related to hyperuricemia and gout (45.29% and 21.48%, respectively). Among 1932 patients, only 25.26% received an appropriate allopurinol prescription. The most commonly prescribed allopurinol dose was "100 mg daily" (89.38%). A statistically significant difference was discovered between appropriate and inappropriate allopurinol prescriptions in terms of sex (p<0.001). Diabetes, dyslipidemia, chronic kidney disease, and cerebrovascular disease were associated with an increased risk of inappropriate prescriptions, with p-values of 0.012, 0.025, <0.001, and 0.044, respectively. Normal and abnormal serum uric acid levels were significantly associated with an increased frequency of inappropriate prescriptions, whereas all patients with "extremely high" serum uric acid levels had valid allopurinol prescriptions (p<0.001). Discussion: Our study revealed that most allopurinol prescriptions in primary care facilities were not indicated. The implementation of clinical guidelines for the management of hyperuricemia is highly recommended.