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Treat-to-target urate-lowering therapy and hospitalisations for gout: results from a nationwide cohort study in England.

Roddy, Edward

Treat-to-target urate-lowering therapy and hospitalisations for gout: results from a nationwide cohort study in England. Thumbnail


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Abstract

Objective To investigate associations between treat-to-target urate-lowering therapy (ULT) and hospitalizations for gout. Methods Using linked Clinical Practice Research Datalink and NHS Digital Hospital Episode Statistics data, we described the incidence and timing of hospitalizations for flares in people with index gout diagnoses in England from 2004–2020. Using Cox proportional hazards and propensity models, we investigated associations between ULT initiation, serum urate target attainment, colchicine prophylaxis, and the risk of hospitalizations for gout. Results Of 292 270 people with incident gout, 7719 (2.64%) had one or more hospitalizations for gout, with an incidence rate of 4.64 hospitalizations per 1000 person-years (95% CI 4.54, 4.73). There was an associated increased risk of hospitalizations within the first 6 months after ULT initiation, when compared with people who did not initiate ULT [adjusted Hazard Ratio (aHR) 4.54; 95% CI 3.70, 5.58; P < 0.001]. Hospitalizations did not differ significantly between people prescribed vs not prescribed colchicine prophylaxis in fully adjusted models. From 12 months after initiation, ULT associated with a reduced risk of hospitalizations (aHR 0.77; 95% CI 0.71, 0.83; P < 0.001). In ULT initiators, attainment of a serum urate <360 micromol/l within 12 months of initiation associated with a reduced risk of hospitalizations (aHR 0.57; 95% CI 0.49, 0.67; P < 0.001) when compared with people initiating ULT but not attaining this target. Conclusion ULT associates with an increased risk of hospitalizations within the first 6 months of initiation but reduces hospitalizations in the long term, particularly when serum urate targets are achieved.

Citation

Roddy, E., Russell, M. D., Rutherford, A. I., Ellis, B., Norton, S., Douiri, A., …Galloway, J. B. (2023). Treat-to-target urate-lowering therapy and hospitalisations for gout: results from a nationwide cohort study in England. Rheumatology, 62(7), 2426-2434. https://doi.org/10.1093/rheumatology/keac638

Journal Article Type Article
Acceptance Date Nov 3, 2022
Online Publication Date Nov 10, 2022
Publication Date Jul 5, 2023
Journal Rheumatology
Print ISSN 1462-0324
Publisher Oxford University Press
Volume 62
Issue 7
Pages 2426-2434
DOI https://doi.org/10.1093/rheumatology/keac638
Keywords gout; crystal arthritis; hospitalizations; urate-lowering therapy; treat-to-target
Publisher URL https://academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/keac638/6820920

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