SAT0451 GOUT FLARES BECOME INFREQUENT DURING A TREAT-TO-TARGET STRATEGY OVER ONE YEAR: DATA FROM THE NOR-GOUT STUDY
Authors: Till Uhlig, Lars Fridtjof Karoliussen, Espen A. Haavardsholm, Tore K. Kvien, Hilde Berner Hammer
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Urate lowering therapy (ULT) is expected to prevent new gout flares. Treat-to-target ULT is however often not performed, and we need more evidence on how often patient become flare- free during ULT. <h3>Objectives:</h3> Urate lowering therapy (ULT) is expected to prevent new gout flares. Treat-to-target ULT is however often not performed, and we need more evidence on how often patient become flare- free during ULT. <h3>Methods:</h3> In a prospective observational study, patients with crystal-proven gout with a recent gout attack and insufficiently treated serum urate (sUA) level (&gt;360 μmol/L/&gt;6 mg/dl) were included. They received ULT with drug escalation during monthly follow-up until the target sUA level was met (sUA &lt;360 μmol/L, or &lt;300 μmol/L if clinical tophi). Assessment in this ongoing data collection included demographic and clinical variables, serum urate levels, previous medication with allopurinol, colchicine and NSAIDs, co-morbidities, and health related quality of life (SF-36). Flares during the last six months of one year with "treat-to-target" were recorded. Bivariate analyses and logistic regression analyses examined factors associated with and prediction (odds ratio with 95% confidence intervals) of a flare-free period during months 6-12. <h3>Results:</h3> 202 patients were included, and 140 completed a 12-month-follow-up: 94.0% males, 90.3% Caucasian, mean (SD) age 56.7 (14.1) years, disease duration 8.0 (7.7) years), sUA level 494 (87) μmol/L, eGFR 78.0 (18.8) ml/min. 58.6% had college education, 76.9% were married/cohabiting, 18.3% had tophi. Allopurinol had at baseline previously been used by 30.0% (54/180), colchicine by 51.8% (100/193) and NSAID by 78.6% (154/196). 70.0% (98/140) of the patients were flare-free between 6 and 12 months, and among patients with flares only 10.2% (4/39) were not at treatment target. 80.9% (106/131) were at treatment target at month 12 (sUA&lt;360 or 300μmol/l). A number of variables at baseline were bivariately (p&lt;0.05) related to a flare-free outcome: male gender, low BMI, no previous use of colchicine or NSAIDs, better physical function summary score (SF-36), low level joint pain during strongest attack ever, and high number (&gt;5) of previous gout attacks. In multivariate logistic regression analyses, also adjusting for age, and gender in the final model, a lower BMI (OR 0.90 per unit, 95% CI 0.83-0.99), low baseline serum urate (OR 0.99 per unit, 95% CI 0.99-1.00) and no previous use of colchicine (OR 4.0, 95% CI 1.6-10.2) predicted a flare-free period between months 6 and 12. When substituted for colchicine, also lack of NSAID use (OR 6.9, 95%CI 1.8-26.1) was a predictor of a flare-free period during this period. <h3>Conclusion:</h3> Most patients (70%) did not experience flares during the second half of the first treat-to-target year during ULT. High baseline level of sUA, and high BMI decreased the chance of a flare free period, as did experience with colchicine or NSAID. <h3>Disclosure of Interests:</h3> Till Uhlig Consultant for: Grünenthal, Novartis, Speakers bureau: Grünenthal, Novartis, Lars Fridtjof Karoliussen: None declared, Espen A Haavardsholm Grant/research support from: research funding from Pfizer, UCB, Roche, MSD, and AbbVie., Tore K. Kvien Grant/research support from: AbbVie, BMS, MSD, Pfizer, Roche and UCB., Consultant for: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Hospira, Merck-Serono, MSD, Novartis, Oktal, Orion Pharma, Pfizer, Roche, Sandoz, Sanofi, Mylan and UCB, Speakers bureau: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Celltrion, Eli Lilly, Hospira, Merck-Serono, MSD, Novartis, Oktal, Orion Pharma, Pfizer, Roche, Sandoz, Sanofi and UCB, Hilde Berner Hammer Grant/research support from: AbbVie, Pfizer and Roche, Paid instructor for: AbbVie, Pfizer, UCB, Novartis, Roche, Speakers bureau: AbbVie, Pfizer, UCB, Novartis, Roche