Treat-to-target urate lowering regimen feasible in most people with gout
medwireNews: A urate lowering treat-to-target approach combined with personalized advice can help the majority of patients with gout achieve satisfactory serum urate (sUA) levels, but some modifiable barriers to target fulfillment still exist, Norwegian researchers report.
“Successful gout management is attainable, and more attention towards addressing modifiable factors could further increase long-term adherence to ULT [urate lowering treatment] and health promoting lifestyle,” write Till Uhlig (University of Olso) and co-authors in RMD Open.
The prospective, observational NOR-Gout study included 211 patients (mean age 56.4 years, disease duration 7.8 years, 95% men) with a recent gout flare and an sUA level above 360 µmol/L.
At baseline, participants either initiated or escalated ULT with allopurinol or febuxostat. They also received information on the disease and disease processes, lifestyle and dietary advice, and discussed their treatment expectations with a trained nurse. Further study visits took place at 1, 2, 3, 6, 9, and 12 months, with a study completion rate of 88.2%.
Uhlig et al found that, at 12 months, 85.5% of the remaining 186 participants had achieved the sUA target of below 360 µmol/L. Mean sUA levels in the full cohort fell from 500 µmol/L at baseline to 311 µmol/L at 12 months. In the subgroup not meeting the target, mean levels fell from 517 µmol/L to 393 µmol/L.
The researchers also note that 69.3% of participants achieved the treatment target by 3 months.
When the team looked for predictors of target attainment, they found that alcohol consumption, belief that medications are overused, and self-efficacy for symptoms, as an indicator for coping, were all significantly associated with outcome after adjustment for age, sex, ethnicity, education level, disease duration, BMI, comorbidity, and baseline sUA.
Specifically, people who consumed alcohol at least weekly were 86% less likely to reach the target than those with less frequent consumption, while each unit increase in the belief that medicines are overused on the Beliefs about Medicines Questionnaire was associated with a 23% lower likelihood of reaching the target.
Conversely, each 10-unit increase on the Arthritis Self-Efficacy Scales symptoms subscale was associated with a 49% increased likelihood of target attainment.
Uhlig and co-investigators say their findings support the belief “that existing treatment recommendations with a focus on ULT as well as information leads to achievement of the treatment target in the majority of [patients with gout].”
They add: “Further research is required to investigate modifiable factors for achieving successful gout outcomes such as target sUA.”
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