THU0446 SUCCESSFUL TREATMENT OF GOUT IS FREQUENT IN CLINICAL PRACTICE WHEN APPLYING A TREAT-TO-TARGET STRATEGY: RESULTS FROM THE NOR-GOUT STUDY
Authors: T. Uhlig, L. F. Karoliussen, T. K. Kvien, E. A. Haavardsholm, H. Berner Hammer
Journal: Annals of the Rheumatic Diseases (2020)

Background: International EULAR and ACR recommendations support lifestyle changes, diet and urate lowering therapy (ULT) in gout. Treat-to-target ULT is often not performed, resulting in insufficient treatment of gout. We studied how many patients achieved the recommended treatment target of &lt;360 µmol/l for serum urate (SUA) when a treat-to-target approach was applied in clinical practice, and which factors predicted reaching this target. Objectives: We studied how many patients achieved the recommended treatment target of &lt;360 µmol/l for serum urate (SUA) when a treat-to-target approach was applied in clinical practice, and which factors predicted reaching this target. Methods: 211 patients with crystal proven gout were included into the prospective, observational NOR-Gout study if they recently had a gout flare as well as insufficiently treated serum urate SUA &gt;360 µmol/l). The intervention consisted of individual verbal information on lifestyle, including factors related to physical activity, diet and the importance of drug adherence. ULT (mainly allopurinol) was initiated and escalated monthly according to EULAR recommendations. Patients were during the first year seen by physician and nurse every three months with additional visits after month 1 and month 2, with further visits monthly as necessary until the treatment target of SUA &lt;360 µmol/l (or &lt;300 if tophi) was met. Baseline age was 53.6 (SD 12.2) years, disease duration 7.8 years (SD 7.6), BMI 28.8 (SD 4.5) kg/m 2 , 95.3% were males. Baseline SUA was 500 (77) µmol/l and 16.6% had subcutaneous tophi. Assessments included questions on frequency of alcohol use, and application of the self-efficacy scales for symptoms (SES, range 10-100) as well as the beliefs in medicines questionnaire (BMQ), which included a scale for general overuse of medicines (range 4-16). 186/211 (88.2%) patients completed the visit for the primary SUA endpoint at 12 months. Results: SUA continuously declined over 12 months and the frequency of responders increased (table 1): Table 1 Responders and SUA levels during the treat-to-target intervention Month Month 0 1 2 3 6 9 12 % n Responders SUA&lt;360 0 0/211 21.3 43/202 48.7 94/193 69.3 131/189 86.7 151/187 81.9 136/166 85.5 159/186 SUA µmol/l (mean, SD) 500 (78) 413 (77) 371 (64) 341 (61) 327 (59) 316 (56) 311 (49) At 12 months 87.6% (163/186) of patients used allopurinol and 13.4% (23/186) febuxostat with mean daily doses of 289 mg (range 100-900) and 59 (20-120) mg, respectively. Reaching the treatment target of SUA after 12 months was bivariately related to work status, alcohol use, and beliefs in general overuse of medicines. In multivariable analyses in the final model also adjusted for baseline SUA, several variables predicted reaching the SUA target of &lt;360 µmol/l: age (per 10 years) (OR 1.5; 95% CI 1.06 – 1.96, p=0.026), alcohol use no more than monthly vs. at least weekly (OR 6.9, 95% CI 1.90 – 25.2, p=0.003), self-efficacy for symptoms (per 10 units) (OR1.31; 95% CI 1.00 – 1.63; p=0.05), and low belief that medicines are generally overused (per decreasing unit) (OR 1.30; 1.04 – 1.62, p=0.019). Conclusion: Most patients (85.5%) with recent gout flare und increased SUA reached the target SUA after 12 months. A good treatment result was predicted by increasing age, less frequent alcohol use, when patients believed they could cope with symptoms and when they did not believe that drugs are generally overused. Disclosure of Interests: : Till Uhlig Consultant of: Lilly, Pfizer, Speakers bureau: Grünenthal, Novartis, Lars Fridtjof Karoliussen: None declared, Tore K. Kvien Grant/research support from: Received grants from Abbvie, Hospira/Pfizer, MSD and Roche (not relevant for this abstract)., Consultant of: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Paid instructor for: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Speakers bureau: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Espen A Haavardsholm Grant/research support from: AbbVie, UCB Pharma, Pfizer Inc, MSD Norway, Roche Norway, Consultant of: Pfizer, AbbVie, Janssen-Cilag, Gilead, UCB Pharma, Celgene, Lilly, Paid instructor for: UCB Pharma, Speakers bureau: Pfizer, AbbVie, UCB Pharma, Celgene, Lilly, Roche, MSD, Hilde Berner Hammer: None declared