P085 Implementing treat-to-target urate-lowering therapy during hospitalisations for gout flares: a prospective cohort study
Authors: Russell Mark D , Ameyaw-Kyeremeh Louise , Dell'Accio Flora , Lapham Heather , Head Natalie , Stovin Christopher , Patel Vishit , Clarke Benjamin , Nagra Deepak , Alveyn Edward , Adas Maryam A , Bechman Katie , de la Puente Maria A , Ellis Benjamin , Byrne Corrine , Patel Rina , Rutherford Andrew I , Cantle Fleur , Norton Sam , Roddy Edward , Hudson Joanna , Cope Andrew P , Galloway James B 
Published: April 2024

Abstract

Background/Aims
Hospitalisations for gout flares have doubled in England during the last 15 years. Despite this, no studies have evaluated strategies designed to increase the uptake of urate-lowering therapy (ULT) in people hospitalised for gout flares.

Methods
We conducted a prospective cohort study in people hospitalised for gout flares. We designed and evaluated an intervention package that consisted of an optimal, in-hospital management pathway based upon BSR, EULAR and ACR guidelines, which encouraged ULT initiation prior to discharge, followed by a nurse-led, post-discharge review. Outcomes including: i) ULT initiation; ii) serum urate target attainment, and iii) re-hospitalisation rates were compared between patients hospitalised for flares in the 12 months post-implementation vs. a retrospective cohort of hospitalised patients from 12 months pre-implementation.

Results
119 and 108 patients, respectively, were hospitalised for gout flares in the 12 months before and after the intervention was launched. For patients with six-month follow-up data available (n = 94 and n = 97, respectively), the proportion of patients who were newly initiated on ULT increased to 92% post-implementation, from 49% pre-implementation (age and sex-adjusted odds ratio (aOR) 11.5; 95% CI 4.36-30.5; p &lt; 0.001). More patients achieved a serum urate ≤360 micromol/L within six months of discharge (27% post-implementation vs. 11% pre-implementation; aOR 3.04; 95% CI 1.36-6.78; p = 0.007). The proportion of patients who were re-hospitalised for flares was 9% post-implementation vs. 15% pre-implementation (aOR 0.53, 95% CI 0.22 to 1.32; p = 0.18).

Conclusion
Following implementation of a strategy designed to optimise care during gout hospitalisations, more than 90% of ULT-naïve patients were initiated on ULT - nearly double the pre-implementation baseline. Despite greater initiation of ULT in the acute flare setting, recurrent hospitalisations did not increase following implementation; supporting the use of ULT in this setting. Improvements were seen in urate target attainment post-discharge; however, focused approaches to optimise ULT dose escalation to achieve target urate levels are required.

Disclosure
M.D. Russell: Honoraria; AbbVie, Biogen, Eli Lilly, Galapagos, Menarini. Grants/research support; Eli Lilly, Janssen, Pfizer, UCB. L. Ameyaw-Kyeremeh: None. F. Dell'Accio: None. H. Lapham: None. N. Head: None. C. Stovin: None. V. Patel: None. B. Clarke: None. D. Nagra: None. E. Alveyn: None. M.A. Adas: None. K. Bechman: Grants/research support; Versus Arthritis/Pfizer. M.A. de la Puente: None. B. Ellis: None. C. Byrne: None. R. Patel: None. A.I. Rutherford: Other; Educational support from Eli Lilly, UCB. F. Cantle: None. S. Norton: None. E. Roddy: None. J. Hudson: None. A.P. Cope: Honoraria; BMS, AbbVie, GSK/Galvini. Grants/research support; BMS. J.B. Galloway: Honoraria; Abbvie, Biovitrum, BMS, Celgene, Chugai, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, Sobi, UCB.