Background Gout is a widely prevalent progressive systemic inflammatory arthritis. The pathogenic cause of gout is elevated serum uric acid or hyperuricemia, and appropriate treatment of gout involves reduction of uric acid levels to a minimum goal of less than 6 mg/dL. Patients who do not achieve uric acid goals are generally described as uncontrolled gout patients and tend to do worse in terms of clinical outcomes such as occurrence of flares and persistence/worsening of tophi. Gout patients often suffer from specific comorbidities, though whether uncontrolled gout patients have a different comorbidity profile is unclear.
Objectives The objectives of this evaluation were to compare the comorbidities and hospitalizations in uncontrolled versus controlled gout patients from a large de-identified US payer database.
Methods A retrospective review of Humana Healthcare data from 2007 to 2016 in private pay and Medicare patients was performed to identify patients with at least 1 gout ICD 10/ICD 9 diagnosis code (N=539,802) and 90 days of continuous urate-lowering therapy within 1 year of diagnosis. Two cohorts of patients were categorized according to their sUA levels (≥ 1 test) after at least 90 days of gout therapy: sUA<6.0 mg/dL (controlled) and sUA ≥8 mg/dL (uncontrolled).
Results The controlled gout group (sUA<6 mg/dL) included 5,473 patients and the uncontrolled gout group (sUA≥8 mg/dL) had 1,358 patients. The two groups were comparable in terms of demographic features. Chronic kidney disease (CKD) was a common comorbidity overall in this gout population with higher prevalence in the uncontrolled gout cohort (49.4% of uncontrolled vs. 32.4% of controlled population; OR 2.04; 95% CI of 1.808 to 2.301, p<0.001). The most frequent hospitalization codes were similar between the uncontrolled and controlled patients with the exception of congestive heart and acute kidney failure. 20% of uncontrolled patients were hospitalized for congestive heart failure vs. 7% in controlled (OR 3.16, 95% CI: 2.674 to 3.739, p<0.001), and 20% of uncontrolled patients were hospitalized for acute kidney failure vs. 8% in controlled (OR 2.95, 95% CI: 2.497 to 3.480, p<0.001).
Conclusion Gout patients frequently suffer from cardiovascular and renal diseases. This large retrospective analysis suggests that when divided based on uric acid levels attained, uncontrolled gout patients are more likely to suffer from CKD and also more likely to be hospitalized for acute renal failure than controlled gout patients. Whether hyperuricemia in uncontrolled gout causes the development of specific cardiovascular and renal comorbidities, or if specific cardiovascular and renal diseases lead to hyperuricemia and uncontrolled gout is not fully established.
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Disclosure of Interests Megan Francis-Sedlak Shareholder of: Horizon Pharma, Employee of: Horizon Pharma, Brian LaMoreaux Shareholder of: Horizon Pharma, Employee of: Horizon Pharma, Robert J Holt Shareholder of: Horizon Pharma, Employee of: Horizon Pharma
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