medwireNews: Results from a prospective cohort study suggest that increased levels of serum CA72-4 at urate-lowering therapy (ULT) initiation are an independent risk factor for recurrent gout flares.
The study included 193 men (mean age 45.3 years) with gout who initiated oral febuxostat 20 mg daily without flare prophylaxis. Participants, who attended in-person visits every 4 weeks during the 24-week follow-up, had a median disease duration of 7.0 years; all had experienced at least one flare in the prior 12 months and had at least three serum CA72-4 measurements in the previous 6 months.
Changgui Li (Affiliated Hospital of Qingdao University, China) and colleagues divided individuals into two groups based on whether or not their highest recorded serum CA72-4 level fell above the upper limit of normal. Overall, 79 patients had a CA72-4 measurement above 6.9 U/mL and were included in the “high” group while the other 114 were assigned to the “normal” arm.
In all, the cumulative incidence of at least one gout flare was 48.1% while the incidence of recurrent (at least two) flares was 33.0%. When comparing both groups, overall flare rates were significantly higher in people with high versus low CA72-4 levels, at 62.1% versus 38.4%, as were rates of recurrent flare, at 47.1% versus 23.2%.
Using a multivariate analysis, the researchers showed that high CA72-4 level, larger intra-articular tophus size, longer disease duration, and increased erythrocyte sedimentation rate were significantly and independently associated with an increased risk for recurrent gout flares at odds ratios of 2.34, 1.97, 1.08, and 1.06, respectively. On the other hand, increasing glucose and high-density lipoprotein cholesterol levels were associated with a risk reduction, with corresponding odds ratios of 0.51 and 0.13.
Writing in Rheumatology, the team reports that high serum CA72-4 levels at ULT initiation predicted recurrent gout flares during follow-up with 63% accuracy. Moreover, when high CA72-4 was combined with the other independent risk factors identified in the study, the accuracy for predicting recurrent gout flares increased to 78%.
These results “suggest the potential to stratify patients who may benefit from gout flare prophylaxis drug treatments,” and that “monitoring the dynamic changes of CA72-4 may allow more rational use of anti-inflammatory prophylaxis,” say the researchers.
However, Li et al note that “all subjects in the study were male and Chinese, so it is uncertain whether the association of CA72-4 with gout flares can be extended to females and other ethnicities.”
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