POS0940 TREATMENT PATTERNS AND QUALITY OF LIFE IN PATIENTS WITH CONTROLLED AND UNCONTROLLED GOUT
Authors: J. Mossell, M. Edwards, E. Goddard, L. Padnick-Silver, B. Lamoreaux
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Gout is associated with high comorbidity burden,[1] health resource utilization,[2,3] healthcare cost,[2] and mortality.[4] Oral urate-lowering therapy (ULT) is the first-line treatment for gout, with American[5] and European[6] rheumatology society guidelines recommending a treat-to-target serum urate level (SU) goal of &lt;6 mg/dL. However, oral ULTs remain heavily underutilized<sup>2</sup> and some patients develop uncontrolled gout, characterized by SU &gt;6 mg/dL with oral ULT use/intolerance and ongoing gout symptoms. Prior studies indicate even greater impact of gout on quality of life,[7] health,[8] and healthcare utilization/cost[9] in patients with uncontrolled disease but the literature comparing controlled and uncontrolled gout is sparse. <h3>Objectives:</h3> To describe treatment patterns and physician-perceived functionality of daily living for patients with controlled and uncontrolled gout. <h3>Methods:</h3> Data were drawn from the Adelphi Gout Disease Specific Programme™, a cross-sectional survey with retrospective data collection of rheumatologists, nephrologists, primary care practitioners (PCPs), and their consulting patients with gout conducted in the United States from August to November 2023. Physicians provided information on patient demographics, patient functional impairment, clinical status, and treatment history for their next 8–13 consecutively consulting patients who were receiving ULT or had uncontrolled disease (defined as SU &gt;6mg/dL and at least one of: ≥1 visible tophus, ≥2 flares in past year, gouty arthropathy). Patients had controlled gout if SU ≤6 mg/dL or SU &gt;6 mg/dL and patient had no tophi, &lt;2 flares/year, and no gouty arthropathy. All data were analyzed descriptively and are presented as mean ± standard deviation (SD) or percentage. <h3>Results:</h3> Overall, 79 physicians (31 PCPs, 33 rheumatologists, 15 nephrologists) reported data for 287 uncontrolled and 241 controlled gout patients. Demographics were as expected for a gout population, as shown for uncontrolled and controlled patients in the <b>Table 1</b>. Of note, all patients with SU &gt;6 mg/dL met the definition for uncontrolled gout. Physicians reported use of ≥1 ULT in most patients. However, 47% of uncontrolled and 46% of controlled patients had never been managed with a treat-to-target approach, most often due to patient preference (uncontrolled: 35%; controlled: 23%), patient noncompliance (24%; 6%), and physician preference (16%; 23%). Physicians perceived most (90%) of their uncontrolled patients as having some degree of functional impairment (<b>Figure 1, Part A</b>), with a subset requiring caregiver help in areas of daily-living (17% uncontrolled, 10% controlled), including ambulating (55%; 8%), dressing (31%; 12%), personal hygiene (29%; 8%), and feeding (20%; 0%; <b>Figure 1, Part B</b>). <h3>Conclusion:</h3> These data highlight the high impact of gout on daily functionality in patients, particularly among those with uncontrolled disease. The fact that most patients had received at least one ULT demonstrates their potential underutilization/underdosing in this population. This study reports physician perspectives on gout; the patient perspective is also needed and is currently being examined in this group of patients. <h3>REFERENCES:</h3> [1] Kuo CF, et al. <i>Ann Rheum Dis</i> 2016;75:210-7. [2] Morlock R, et al. <i>Rheumatol Ther</i> 2016;3:53-75. [3] Rai SK, et al. <i>Semin Arthritis Rheum</i> 2015;45:75-80. [4] Kuo CF, et al. <i>Rheumatology (Oxford</i>) 2010;49:141-6. [5] FitzGerald JD, et al. <i>Arthritis Care Res (Hoboken</i>) 2020;72:744-60. [6] Richette P, et al. <i>Ann Rheum Dis.</i> 2017;76:29-42. [7] Watson L, et al. <i>Rheumatology (Oxford</i>) 2023;62:2748-56. [8] Francis-Sedlak M, et al. <i>Rheumatol Ther</i> 2021;8:183-97. [9] Flores NM, et al. <i>J Med Econ.</i> 2019;22:1-6. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> James Mossell Abbvie, Amgen, Inc., GSK, UCB, Mallinckrodt, Aurinia, Amgen, ANI, Boehringer Ingelheim, and Scipher, Molly Edwards: None declared, Emily Goddard: None declared, Lissa Padnick-Silver Amgen, Inc., Amgen, Inc., Brian LaMoreaux Amgen, Inc., Amgen, Inc.