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Serum urate outcomes of treat-to-target urate lowering treatment: results of a nationwide cohort study from 1997 to the COVID-19 pandemic using data from the Clinical Practice Research Datalink
  1. Abhishek Abhishek1,
  2. Edoardo Cipolletta1,2,
  3. Georgina Nakafero1,
  4. Anthony J Avery3,
  5. Mamas Mamas4,
  6. Laila J Tata3
  1. 1 Academic Rheumatology, University of Nottingham, Nottingham, UK
  2. 2 Clinica Reumatologica, Universita Politecnica delle Marche, Jesi, Ancona, Italy
  3. 3 Population and Lifespan Sciences, University of Nottingham, Nottingham, UK
  4. 4 Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK
  1. Correspondence to Professor Abhishek Abhishek, Academic Rheumatology, University of Nottingham, Nottingham NG7 2RD, Nottinghamshire, UK; abhishek.abhishek{at}

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Despite long-standing recommendations,1–3 most gout patients prescribed urate lowering treatment (ULT) do not achieve serum urate (SU) target.4 The time between treat-to-target (T2T) recommendations and achievement of SU treatment target, and how the latter was impacted by the COVID-19 pandemic has not been evaluated. We used UK-wide nationally representative primary-care data from the Clinical Practice Research Datalink (CPRD) GOLD to evaluate temporal trends in achievement of T2T–SU levels within 12 months of first ULT prescription in successive years from 1997 to 2020. CPRD contains anonymised healthcare records from >18 million individuals, originating during their routine care in the National Health Service, a healthcare system with universal coverage.5

This study spanned from 01 January 1997 to 31 December 2021. Prevalent gout cases age≥18 years, first prescribed ULT in the study period was followed from the first prescription to earliest of prescription end, death, transfer out, last data collection, 12 months after ULT prescription or 31 December 2021. Participants were required to have≥1 year ULT prescription-free registration prior to study entry to prevent prevalent ULT users appearing as new users. Gout and ULT prescription status were defined using Read and product codes.6

Prevalence (95% CI) of achieving SU<360 and <300 µmol/L within 12 months of ULT initiation were calculated. The latest SU within 12 months of ULT initiation was used to define achievement of target thresholds. Cox proportional HR with 95% CI …

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  • Handling editor Josef S Smolen

  • Contributors AA conceived the idea for the study, contributed to the study design, performed the analysis, interpreted the results and critically reviewed the paper. AJA contributed to the study design, interpretation of the results and critically reviewed the paper. EC advised on interpretation of results and critically reviewed the paper. LJT contributed to the study design, advised on the analysis and interpretation of the results and critically reviewed the paper. MM contributed to the study design and critically reviewed the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AA has received departmental research grants from AstraZeneca and Oxford Immunotec, speaker bureau fees from Menarini, Cadilla Pharmaceuticals, scientific meeting support from Pfizer, consulting fees from Inflazome and author royalties from UpToDate and Springer, unrelated to this work. The other authors have no conflict of interest to declare.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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