Determinants of Achieving Serum Urate Goal with Treat-to-Target Urate-Lowering Therapy in Gout.

Autor: Helget LN; Veterans Affairs (VA) Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha., O'Dell JR; Veterans Affairs (VA) Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha., Newcomb JA; Veterans Affairs (VA) Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha., Androsenko M; VA Boston Cooperative Studies Program Coordinating Center, Boston, Massachusetts., Brophy MT; VA Boston Cooperative Studies Program Coordinating Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts., Davis-Karim A; VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico., England BR; Veterans Affairs (VA) Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha., Ferguson R; VA Boston Cooperative Studies Program Coordinating Center and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts., Pillinger MH; VA New York Harbor Health Care System and New York University Grossman School of Medicine, New York., Neogi T; Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts., Palevsky PM; VA Pittsburgh Health Care System and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Wu H; VA Boston Cooperative Studies Program Coordinating Center, Boston, and Babson College, Wellesley, Massachusetts., Kramer B; Veterans Affairs (VA) Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha., Mikuls TR; Veterans Affairs (VA) Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha.
Jazyk: angličtina
Zdroj: Arthritis & rheumatology (Hoboken, N.J.) [Arthritis Rheumatol] 2024 Apr; Vol. 76 (4), pp. 638-646. Date of Electronic Publication: 2023 Dec 26.
DOI: 10.1002/art.42731
Abstrakt: Objective: Using trial data comparing treat-to-target allopurinol and febuxostat in gout, we examined participant characteristics associated with serum urate (SU) goal achievement.
Methods: Participants with gout and SU ≥6.8 mg/dL were randomized to allopurinol or febuxostat, titrated during weeks 0 to 24, and maintained weeks 25 to 48. Participants were considered to achieve SU goal if the mean SU from weeks 36, 42, and 48 was <6.0 mg/dL or <5 mg/dL if tophi were present. Possible determinants of treatment response were preselected and included sociodemographics, comorbidities, diuretic use, health-related quality of life (HRQoL), body mass index, and gout measures. Determinants of SU response were assessed using multivariable logistic regression with additional analyses to account for treatment adherence.
Results: Of 764 study participants completing week 48, 618 (81%) achieved SU goal. After multivariable adjustment, factors associated with a greater likelihood of SU goal achievement included older age (adjusted odds ratio [aOR] 1.40 per 10 years), higher education (aOR 2.02), and better HRQoL (aOR 1.17 per 0.1 unit). Factors associated with a lower odds of SU goal achievement included non-White race (aORs 0.32-0.47), higher baseline SU (aOR 0.83 per 1 mg/dL), presence of tophi (aOR 0.29), and the use of diuretics (aOR 0.52). Comorbidities including chronic kidney disease, hypertension, diabetes, and cardiovascular disease were not associated with SU goal achievement. Results were not meaningfully changed in analyses accounting for adherence.
Conclusions: Several patient-level factors were predictive of SU goal achievement among patients with gout who received treat-to-target urate-lowering therapy (ULT). Approaches that accurately predict individual responses to treat-to-target ULT hold promise in facilitating personalized management and improving outcomes in patients with gout.
(© 2023 American College of Rheumatology.)
Databáze: MEDLINE
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