POS0027 EVALUATING TREAT TO TARGET BENCHMARKS AMONGST OLDER ADULTS WITH GOUT INITIATING URATE LOWERING THERAPY IN ONTARIO, CANADA
Authors: T. Kwok, B. Kuriya, L. Eder, G. A. Hawker, P. LI, G. Choy, J. Widdifield
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Treat to target (T2T) serum uric acid (SUA) levels in patients with gout on urate lowering therapy (ULT) is associated with decreased flares and tophaceous complications. The achievement of T2T benchmarks in older adults with gout initiating ULT is unknown. <h3>Objectives:</h3> To evaluate the percentage of patients aged ≥66 achieving SUA &lt;360 µmol/L in the first year after initiating ULT, and to explore factors associated with achieving this benchmark. <h3>Methods:</h3> This population-based retrospective cohort study used Ontario health administrative databases and included patients aged ≥66 with gout newly dispensed ULT between January 1, 2010, and March 31, 2019. Achieving a target SUA (&lt;360 µmol/L) within 12-months after ULT dispensation was assessed overall, annually and by specialty amongst patients with ≥1 SUA test after starting ULT. Multi-level logistic regression clustered by ULT prescriber evaluated factors associated with achieving target SUA. <h3>Results:</h3> Among 44,438 patients (mean (SD) age 76.0±7.3 years; 64.4% male) prescribed ULT between 2010 and 2019, 30,057 patients (67.6%) had at least one SUA test completed during the first 12-months of ULT use and were included in the analyses. Overall, 52.3% of patients achieved a SUA on target within a year of treatment initiation, ranging from 45.2% in 2010 to 61.2% in 2019 (p &lt; 0.0001). Rheumatology patients were significantly more likely to be treated to target with improvements across all specialties over time (Figure 1). In the logistic regression model, independent factors associated with reaching SUA target were febuxostat use (OR 11.40, 95% CI 5.10–25.43), ULT adherence (OR 5.17, 95% CI 4.89–5.47), allopurinol starting doses &gt;50 mg (OR 2.53, 95% CI: 2.14–2.99), &gt;2 ULT dose titrations (OR 1.49, 95% CI: 1.12–1.98), co-prescription of colchicine/oral corticosteroids (OR 1.24, 95% CI: 1.14–1.34), hypertension (OR 1.10, 95% CI: 1.01–1.20), cancer (OR 1.21, 95% CI: 1.04–1.41) and increasing patient age (OR 1.01, 95% CI 1.01–1.01). SUA monitoring (&gt;2 tests) was associated with a lower odds of achieving SUA target (OR: 0.42, 95% CI: 0.39–0.45). Compared with rheumatologists, patients of family physicians (OR 0.36, 95% CI: 0.33–0.41), internists (OR 0.44, 95% CI: 0.38–0.51), nephrologists (OR 0.33, 95% CI: 0.27–0.40) and other specialties (OR 0.45, 95% CI 0.38–0.53) were less likely to achieve SUA target. Patients of younger/newer physicians (OR 0.87, 95% CI: 0.80–0.95) and male patients (OR 0.66, 95% CI: 0.63–0.70) were less likely to meet SUA targets as were patients in the lowest income quintile (OR 0.92, 95% CI: 0.84–0.99), with other comorbidities and concomitant diuretic and losartan use (Table 1). <h3>Conclusion:</h3> Despite improvements over time, this study found that only 52.3% of patients achieved an optimal SUA level within 1 year of ULT initiation. Febuxostat use, ULT adherence and higher allopurinol starting doses had the strongest association with achieving SUA treatment target. SUA monitoring itself was not beneficial, suggesting the importance of concomitant ULT dose titrations. This study highlights room for improvement in gout management in Canada and potential strategies to address care gaps. <b>Table 1.</b> Logistic regression analysis for factors and their association with achieving SUA &lt;360 μmol/L at 12 months of starting ULT <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> PSI Foundation. <h3>Disclosure of Interests:</h3> <b>None declared.</b>