Hotea I. (1,2), Giesen T. (1), Comarniceanu A. (1), Efde M. (1), Van Osch F. (3), Janssen M. (1), Jansen Tltha (1,4).
Affiliation(s):
1. Department Of Rheumatology, Viecuri Medical Centre, Venlo The Netherlands
2. Departament Of Rheumatology, University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca
3. Leerhuis, Viecuri Medical Centre, Venlo, The Netherlands
4. Department of Medical Cell Biophysics (Mcb), University of Twente, Enschede, The Netherlands
Objectives: The aim of this study is to assess outcomes of gout patients from the Treat to target perspective at 6 months and 12 months while using urate lowering therapy (ULT): allopurinol, febuxostat and benzbromarone. The study was conducted including patients that visited the Rheumatology department from a hospital in Netherlands within a 5 year period.
Methods: All gout patients diagnosed from 2015 to 2021 were identified from the digital hospital system. Diagnosis gout was retrieved from ICD10 code and based on meeting the ACR/EULAR 2015 classification criteria [1]. Data was store anonymously and contained demographic data, clinical variables, laboratory parameters at baseline and at 6 months and 12 months follow-up and medication used. Patient outcomes were predefined in 3 Intention To Treat (ITT) categories (see flow diagram ): category 1: patients with serum uric acid (sUA) ≤ 0.360 mmol/l but >0,300mmol/l ( ACR target for gout), category 2 with sUA ≤ 0,300 mmol/l ( ACR/EULAR target for severe gout) , category 3 patients with sUA>0.360 (failure to meet ACR target. Predictors for reaching the sUA target were analyzed using linear regression. The OR was presented with a 95% CI. p < 0.005 was considered as statistically significant.
Results: Gout diagnoses were present in 1186 patients: 986 (83.1%) males and 200 (16.9%) females. A visit at 6 months was present in 76.9% (n=856) out of 1113 patients reaching sUA< 0.36 mmol/L, but 257 (23%) failed to reach 0.36mmol/L target. At 12 months follow-up data were available in 792 (71.1%)) patients, and from these 710 (90%), had reached sUA<0.36mM target, and even 585, (74%) of 792, sUA≤0.30 mmol/L target. The prescribed dose of allopurinol and achievement of the stricter sUA≤0.30 mol/l target at 6 months were correlated: r -0.1795, 95% CI -0.2558 to -0.101 (p<0.001). The use of benzbromarone was a strong predictor of reaching the sUA<0.30 mmol/L Target: OR 3.2, CI 95%1.735 to 6.017 at 6 and 12 months follow-up. Diabetic patients had the highest proportion of not being on target: 18 %. In order to reach the sUA target at 6 months the male patients in general needed a higher dose of allopurinol.
Conclusion: This is the largest study on a Treat to target approach in gout, based in a real-life clinical setting. About 77% of gout patients managed to reach the predefined sUA targets at 6 months with 3 ULTs available, but there is it still a number of patients failing to achieve predefined sUA targets and in whom more potent alternatives are needed. Reference: 1) Tuhina Neogi, 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2015;74:1789-1798.