Gout characteristics, comorbidities and management in a long primary care database from Catalonia: the GotAP study.
Maria Antonia Pou, Carlen Reyes, Daniel Martinez-Laguna, Pau Satorra, Cristian Tebe, Nicola Dalbeth, Cesar Diaz-Torne
Affiliation(s):
Rheumatology Department. Hospital De La Santa Creu I Sant Pau, Barcelona. Grempal Study Group. Ics. Barcelona
Background: Although gout treatment is well established, its management has been proven to be insufficient in all healthcare settings with clinical and treatment differences between regions.
Objective: To describe demographic, disease and treatment characteristics in a cohort of incident gout patients over the last decade.
Methods: A retrospective cohort study using a primary-care database (SIDIAP) with routinely collected medical records and pharmacy dispensations covering more than 75% population of Catalonia, Spain (~6 million people). People with an incident gout diagnose were included and followed from 2012 to 2023. Sociodemographic features, medications adherence (Medication Possession Ratio (MPR) > 80% was considered a good adherence) and uric acid levels (more than 80% of the time in the study with target uric acid was considered good control) were collected.
Results: 97,239 persons were included. Median follow up was 5.4 [2.5; 8.2] years. 79.9% were male with mean age of 66.3±14.6 years and mean BMI of 30.1±5.0 kg/m2. Uric acid level previous to diagnose of gout was 8.00 [6.90; 9.00] mg/dl.
At gout diagnose, 65.3% had hypertension, 50.9% dyslipidaemia, 24.3% diabetes mellitus 2, 11.1% ischemic heart disease, 6.8% cerebrovascular disease, 32.9% stage III to V chronic kidney disease (CKD) and 4.6% alcohol abuse.
During follow-up, uric acid levels were never measured in 11.2% of the patients and 37.0% never received urate lowering therapy (ULT). Initial ULT were alopurinol (94.9%), febuxostat (5.0%) and benzbromarone (0.05%). When analysing the last ULT, patients with febuxostat were younger (70.6 vs 72.4 years old), treated before (2.6 vs 3.3 years) and had CKD (56.5 vs 42.0%) compared to alopurinol patients. Patients with ischemic heart disease patients were more frequently treated with alopurinol (14.4 vs 12.3%). Treatment adherence was greater among febuxostat (50.3% vs 5.7%). Mean duration of allopurinol was 111.5 [25; 208] days, whereas for febuxostat 179 [56; 546]. In 25% of the patients ULT treatment did not arrive to 25 days.
The first ULT treatment was initiated 1.8 [0.5; 8.5] months after the gout diagnose and its duration was 3.72 [0.8; 9.8] months. Prevalence and incidence of ULT during the study and differences between male and female are shown in figure 1.
12.4% of the patients had a good control. Good control did not change according to the number of uric levels tests done, year of diagnose or time of follow-up.
Characteristics associated to a good control were: time under ULT, alopurinol dose (100 vs 212.5 mg/day), MPR, treatment with febuxostat, cerebrovascular disease and diabetes mellitus. Characteristics against a good gout control were: being male, time to the beginning of ULT, higher BMI, CKD III-IV, dyslipidaemia, hypertension, alcohol abuse and Charlson Index. Association between adherence and good control is shown in figure 2.
Prevalence and incidence of good control during the study and differences between male and female are shown in figure 1.
Conclusions: The majority of patients have cardiovascular comorbidities. Most of the patients are undertreated and have a poor adherence to ULT. Being a female, starting of ULT after diagnose, using febuxostat, using high doses of alopurinol and having a greater MPR is associated to a better control of gout. Women were less treated than men but had better outcomes. Management of gout has not improved during the last decade.
