Background Gouty arthritis is a common, potentially disabling and increasingly prevalent disease . Last year, the European League Against Rheumatism (EULAR) task force gout updated the 2006 recommendations for the management of gout [2,3]. The guideline stresses the application of a targeted approach when initiating urate lowering therapy (ULT) in gout patients for reaching the recommended serum urate (sUA) target values. However, data on clinical outcomes of real-world gout patients treated according to this approach are limited.
Objectives To examine the clinical outcomes achieved in two patient cohorts in which differing targeted ULT treatment approaches were employed, both aiming to reach the EULAR recommended sUA targets.
Methods We conducted a retrospective chart review study. Gout patients were included that had been treated at the rheumatology departments of two clinical centers in the Netherlands, applying different targeted ULT treatment approaches. Patients in cohort A followed an approach combining two modes of action once allopurinol monotherapy failed to reach the predefined target, whereas patients in cohort B were treated with sequential monotherapy following allopurinol monotherapy failure. Outcome parameters were defined to reflect the EULAR recommendations concerning ULT .
Results A total of 177 patients were included in the study; 99 in cohort A and 78 in cohort B. The majority (N=146, 82.5%) of the included patients from both cohorts were able to meet the predefined sUA target of <360 μmol/L. In addition, more than half (N=104, 58.8%) of the patients reached the stringent sUA target of <300 μmol/L. The proportion of patients reaching sUA targets did not differ significantly (p=0.51) between the cohorts, with 80.8% (n=80) of the patients in cohort A reaching the primary sUA target, compared to 85.7% (n=66) in cohort B (Figure 1). In total, patients following treatment with first-line allopurinol, second-line monotherapy options or second-line combination therapy, 102/124 (82.3%), 25/31 (80.6%) and 19/21 (90.5%) respectively, reached the primary sUA target.
Conclusions This chart review provides a proof-of-concept of the treat-to-target approach in gout patients when a targeted approach with ULT is applied. However, our study also shows that not all patients may reach targets using currently available treatment options. Prospective, pragmatic randomized studies to investigate differences between specific treatment regimes in gout patients, together with costs, safety and patient-reported outcome measures are needed.
Kuo C-F, Grainge MJ, Zhang W, et al. Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol 2015;11:649–62. doi:10.1038/nrrheum.2015.91.
Zhang W, Doherty M, Bardin T, et al. EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2006;65:1312–24. doi:10.1136/ard.2006.055269.
Richette P, Doherty M, Pascual E, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2017;76:29–42. doi:10.1136/annrheumdis-2016–209707.
Disclosure of Interest None declared