OP0049 FACTORS ASSOCIATED WITH EARLY FLARES WHEN INITIATING URATE LOWERING THERAPIES. POST HOC ANALYSIS OF CLEAR 1,2 AND CRYSTAL TRIALS
Authors: Pascal Richette, Fernando Perez-Ruiz, Ravi Karra, Augustin Latourte, Imane Wild, Prashanth Kandaswamy, Heiko Hagedorn, Thomas Bardin
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Initiation of urate lowering therapies (ULT) in patients with gout can trigger flares which could contribute to poor treatment adherence. The EULAR guidelines recommend a prophylactic treatment with colchicine or low dose NSAIDs for up to 6 months. However, long term treatment with either NSAIDs or colchicine can be poorly tolerated or contra-indicated. Thus, identification of risk factors for flares to identify patients who would benefit more from a prophylactic treatment could improve patients care. <h3>Objectives</h3> To investigate the influence of patient and treatment related factors on the occurrence of flares 1 month after the initiation of ULT. <h3>Methods</h3> Data are from n=1018 patients (mean age 52.0 (SD 11.1) years; 95.2% male) not responding to allopurinol or febuxostat monotherapy and who received lesinurad (200 mg or 400 mg) in the CLEAR and CRYSTAL trials. Patients were prescribed colchicine (84%) or NSAIDs (12.9%) as prophylactic treatment. Data from 3 trials were pooled and the following covariates were considered in the main analysis using a Generalized Estimation Equation (GEE) model: age, gender, serum uric acid (SUA) levels, baseline body mass index, renal function, and presence of tophus, type of gout flare prophylaxis, triglycerides, comorbidities (smoking, tobacco, diabetes, hypertension, hyperlipidemia) antihypertensive and lipid lowering medications at baseline and newly started and change in SUA levels. A multivariate analysis was conducted using the occurrence of flares as response measured from baseline until month 1 <h3>Results</h3> In the multivariate analysis, tophus at baseline and gender (female) were both associated with an increased risk of early flares: OR=2.7 (95% CI: 1.7-4.2) and OR=1.8 (95%: CI 1.0-3.4), respectively, whereas hyperlipidemia and hypertension were associated with a decreased risk of flares: OR=0.64 (95%: CI 0.45-0.91) and OR= 0.62 (95%: CI 0.39-0.99). There was a trend toward a reduced risk of flares with colchicine versus NSAIDs: OR=0.71 (95%: CI 0.47-1.05). Neither the duration of gout nor the change in SUA levels modified the risk of flares. <h3>Conclusion</h3> This analysis shows that gender (female) and tophus are independent risk factors of early flares when initiating ULT, and suggests that colchicine might be more effective than low dose NSAIDs as prophylactic treatment. <h3>Disclosure of Interests</h3> Pascal Richette Consultant for: Grunenthal, Horizon, Speakers bureau: AstraZeneca, Grunenthal, Fernando Perez-Ruiz Grant/research support from: Cruces Rheumatology Association, Consultant for: Grunenthal, Menarini, Horizon, Speakers bureau: Menarini, Grunenthal; Spanish foundation for rheumatology, Ravi Karra Employee of: Grunenthal, Augustin Latourte: None declared, Imane Wild Employee of: Grunenthal, Prashanth Kandaswamy Employee of: Grunenthal, Heiko Hagedorn Employee of: Grunenthal, Thomas Bardin Consultant for: Astrazeneca, Grunenthal, Horizon, Novartis, Speakers bureau: Astella, AstraZeneca, Grunenthal.