Several Factors Influence Serum Urate Goal Achievement in ULT for Gout

Using trial data, a study in Arthritis & Rheumatology compared 2 treat-to-target urate-lowering therapies (ULTs), allopurinol and febuxostat, to determine the participant characteristics associated with serum urate (SU) goal achievement.

The study enrolled patients with gout who had a baseline SU level of ≥6.8 mg/dl. The patients were randomly assigned to receive either allopurinol or febuxostat, and their treatment was titrated during weeks 0 to 24, followed by maintenance from weeks 25 to 48. SU goal achievement was defined as having a mean SU level of <6.0 mg/dl during weeks 36, 42, and 48 or <5 mg/dl of tophi present.

To understand patient characteristics that influence SU goal achievement, investigators analyzed various factors, including sociodemographics, comorbidities, diuretic use, health-related quality of life (HRQoL), body mass index, and gout-related measures. Determinants of SU response were evaluated using multivariable logistic regression, and additional analyses were conducted to consider treatment adherence.

The study included 764 patients who completed the 48-week treatment period. Overall, 81% of these patients successfully achieved their SU goals.

After adjusting for multiple factors, older age was associated with a greater likelihood of SU goal achievement, with 40% increased odds for every 10-year increase in age. Higher levels of education were also linked to a more than 2-fold increase in the odds of reaching the SU goal. Additionally, better HRQoL was associated with a 17% higher likelihood of achieving the goal for every 0.1-unit increase.

Conversely, non-White race, higher baseline SU levels, the presence of tophi, and the use of diuretics were associated with reduced odds of SU goal achievement. Non-White participants had odds ranging from 0.32 to 0.47. Higher baseline SU levels were associated with a 17% lower likelihood of goal achievement for every 1-mg/dl increase. The presence of tophi reduced the odds of achievement by 71%, and the use of diuretics decreased the odds by 48%.

The investigators found that comorbidities such as chronic kidney disease, hypertension, diabetes, and cardiovascular disease were not significantly associated with SU goal achievement. This finding suggests that the presence of these common health conditions did not appear to hinder the success of treat-to-target ULT.

“Approaches that accurately predict individual responses to treat-to-target ULT hold promise in facilitating personalized management and improving outcomes in patients with gout,” the investigators concluded.