Comparative Study of Real‐Life Management Strategies in Gout: Data From Two Protocolized Gout Clinics

Kampe, Ritch Te; Durme, Caroline van; Janssen, Matthijs; Eijk-Hustings, Yvonne van; Boonen, Annelies; Jansen, Tim L.

doi:10.1002/acr.23995

Cited by 5 publications

(4 citation statements)

References 35 publications

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“…Our real-life results of over 1,100 patients with a T2T strategy showed that it is feasible in about 80% to get to a more lenient 0.36 mmol/L target, comparable or somewhat less when compared with a real-life study from Norway [4], with only 2 urate lowering drugs, i.e., allopurinol and febuxostat, and the British nurse-led gout study in which 95% reached the 0.36 mmol/L target [5]. The presented results align with previous Dutch work showing that a strict urate-driven therapy using a urate-driven approach reached the biochemical sUA < 0.36 mmol/L target in about 85% of patients [6,7].…”

Section: Discussionsupporting

confidence: 80%

Real-life results of urate-driven pharmacotherapy with three urate lowering drugs in gout: allopurinol, febuxostat and benzbromarone

Hotea,

Giesen,

Comarniceanu

et al. 2023

Explor Musculoskeletal Dis

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Aim: This study aims to assess outcomes of gout patients from the treat to target (T2T) perspective at 6 months and 12 months while using urate lowering therapy (ULT): allopurinol, febuxostat, and/or benzbromarone. Methods: All gout patients visiting the Rheumatology department between 2015 to 2021 were identified from the digital hospital system. The diagnosis of gout was based on the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2015 classification criteria. Patient outcomes were predefined intention to treat (ITT) categories: category 1: patients with serum uric acid (sUA) ≤ 0.360 mmol/L (ACR target for gout); category 2: patients with sUA ≤ 0.300 mmol/L (ACR/EULAR target for severe gout); category 3: patients with sUA > 0.360 (failure to meet ACR target). Results: Gout diagnoses were present in 1,186 patients: 986 (83.1%) males and 200 (16.9%) females. A follow-visit at 6 months was present in 76.9% (n = 856) out of 1,113 patients reaching sUA < 0.36 mmol/L, but 257 (23%) failed to reach the 0.36 mmol/L target. At 12 months, a follow-up visit was available in 792 (71.1%) patients, and from these, 710 (90%) had reached sUA < 0.36 mmol/L target. The use of benzbromarone was a strong predictor of reaching the sUA < 0.30 mmol/L target: odds ratio (OR) 3.2, 95% confidence interval (CI) (1.735, 6.017) at 6 months. Diabetic patients had the highest proportion of not reaching the target: 18%. Male patients needed higher dosages of allopurinol to reach the sUA target at 6 months compared to female patients. Conclusions: This is a large study on a T2T approach based in a real-life clinical setting. Only 42% reached the sUA target at 6 months with allopurinol 300 mg quaque die (QD) monotherapy. About 77% of gout patients reach the predefined sUA target of 0.36 mmol/L at 6 months with the availability of three ULTs. There is still a significant unmet need in gout as many patients failed to achieve predefined sUA targets.

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Section: Discussionsupporting

confidence: 80%

Real-life results of urate-driven pharmacotherapy with three urate lowering drugs in gout: allopurinol, febuxostat and benzbromarone

Hotea,

Giesen,

Comarniceanu

et al. 2023

Explor Musculoskeletal Dis

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“…During follow-up, an sUA value of <360µml/L was numerically more frequently reached in the more ambitious approach by 83% versus 74%, but differences were not statistically significant. 28 In a Mexican study, the target sUA was achieved in only 50%–70% after 3–4 years in spite of regular visits, 29 and response rates by 12 months among general practitioners in the UK with sUA <360 µmol/L were 45%. 30 …”

Section: Discussionmentioning

confidence: 95%

“…The response rate in a randomised controlled trial from Nottingham, UK, was even higher than in our study with 95% after both 1 and 2 years, when care was provided by a nurse combining ULT and education as compared with primary care. 20 A recent study from the Netherlands compared two treatment strategies, 28 a more ambitious approach with a target of sUA <300 mol/L as compared with a target <360 µmol/L. During follow-up, an sUA value of <360µml/L was numerically more frequently reached in the more ambitious approach by 83% versus 74%, but differences were not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

12-month results from the real-life observational treat-to-target and tight-control therapy NOR-Gout study: achievements of the urate target levels and predictors of obtaining this target

et al. 2021

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ObjectivesGout is often not adequately treated, and we aimed to apply urate lowering treatment (ULT) combined with individual information to achieve target serum urate (sUA) in clinical practice, and to identify predictors of achievement of this sUA target.MethodsPatients with a recent gout flare and sUA >360 µmol/L (>6 mg/dL) were consecutively included in a single-centre study and managed with a treat-to-target approach combining nurse-led information about gout with ULT. All patients were assessed with tight controls at baseline, 1, 2, 3, 6, 9 and 12 months including clinical examination, information on demographics, lifestyle, self-efficacy and beliefs about medicines. The treatment target was sUA <360 µmol/L and multivariable logistic regression was used to identify predictors of target attainment with ORs and 95% CIs.ResultsOf 211 patients (mean age 56.4 years, disease duration 7.8 years, 95% males), 186 completed the 12-month study. Mean sUA levels decreased from baseline mean 500 to 311 µmol/L at 12 months with 85.5% achieving the treatment target. Alcohol consumption at least weekly versus less frequently (OR 0.14; 95% CI 0.04 to 0.55) as well as beliefs in overuse of medicines (OR per unit 0.77; 95 CI 0.62 to 0.94) decreased the chance of reaching the treatment target, while higher self-efficacy for arthritis symptoms (OR 1.49 per 10 units; 95% CI 1.09 to 2.05) increased the likelihood.ConclusionsThis study shows that target sUA can be achieved with ULT in most patients. Less self-reported alcohol consumption, low beliefs in overuse of medicines and higher self-efficacy are associated with treatment success.

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“…In this treat-to-target (T2T) approach, serum urate is lowered by increasing the dose or combining ULT until the target of <0.36mmol/l (6mg/dl) or even <0.30mmol/l (5mg/dl) in patients with tophi, severe polyarticular gout and/or erosions is reached [3][4][5][6] and maintained at target. Although globally rheumatologists strongly believe in a continued T2T approach [7], an alternative strategy also commonly used in daily practice is a treat-to-avoidsymptoms (T2S) approach [8]. In this T2S strategy, ULT is solely dosed on symptoms, regardless of serum urate levels.…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

Urate-lowering therapy following a treat-to-target continuation strategy compared to a treat-to-avoid-symptoms discontinuation strategy in gout patients in remission (GO TEST Finale): study protocol of a multicentre pragmatic randomized superiority trial

Peeters

Broeder

Taylor

et al. 2023

Trials

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Background Long-term gout treatment is based on reducing serum urate levels using urate-lowering therapy (ULT). Most guidelines recommend using a lifelong continuation treat-to-target (T2T) strategy, in which ULT is dosed or combined until a serum urate target has been reached and maintained. However, a frequently used alternative strategy in clinical practice is a treat-to-avoid-symptoms (T2S) ULT discontinuation strategy, with the possibility of restarting the medication. This latter strategy aims at an acceptable symptom state, regardless of serum urate levels. High-quality evidence to support either strategy for patients in prolonged remission while using ULT is lacking. Methods We developed an investigator-driven pragmatic, open-label, multicentre, randomized, superiority treatment strategy trial (GO TEST Finale). At least 278 gout patients using ULT who are in remission (>12 months, preliminary gout remission criteria) will be randomized 1:1 to a continued T2T strategy (treatment target serum urate < 0.36 mmol/l) or switched to a T2S discontinuation strategy in which ULT is tapered to stop and restarted in case of (persistent or recurrent) flaring. The primary outcome is the between-group difference in the proportion of patients not in remission during the last 6 months of 24 months follow-up and will be analyzed using a two proportion z test. Secondary outcomes are group differences in gout flare incidence, reintroduction or adaptation of ULT, use of anti-inflammatory drugs, serum urate changes, occurrence of adverse events (with a special interest in cardiovascular and renal events), and cost-effectiveness. Discussion This study will be the first clinical trial comparing two ULT treatment strategies in patients with gout in remission. It will contribute to more specific and unambiguous guideline recommendations and improved cost-effectiveness of long-term gout treatment. It also paves the way (exploratory) to individualized long-term ULT treatment. In this article, we elaborate on some of our trial design choices and their clinical and methodological consequences. Trial registration International Clinical Trial Registry Platform (ICTRP) NL9245. Registered on 2 February 2021 (METC Oost-Nederland NL74350.091.20); EudraCT EUCTR2020-005730-15-NL. Registered on 11 January 2021.

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Comparative Study of Real‐Life Management Strategies in Gout: Data From Two Protocolized Gout Clinics

Cited by 5 publications

References 35 publications

Real-life results of urate-driven pharmacotherapy with three urate lowering drugs in gout: allopurinol, febuxostat and benzbromarone

Real-life results of urate-driven pharmacotherapy with three urate lowering drugs in gout: allopurinol, febuxostat and benzbromarone

12-month results from the real-life observational treat-to-target and tight-control therapy NOR-Gout study: achievements of the urate target levels and predictors of obtaining this target

Urate-lowering therapy following a treat-to-target continuation strategy compared to a treat-to-avoid-symptoms discontinuation strategy in gout patients in remission (GO TEST Finale): study protocol of a multicentre pragmatic randomized superiority trial

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