The following is a summary of “Adherence and Treat-to-Target Benchmarks in Older Adults With Gout Initiating Urate-Lowering Therapy in Ontario, Canada: A Population-Based Study,” published in the June 2024 issue of Rheumatology by Kwok et al.

Researchers conducted a retrospective study assessing adherence to urate-lowering therapy (ULT) and attainment of treatment-to-target (T2T) serum uric acid (SUA) levels in older adults with gout.

They enrolled patients aged ≥66 who were newly prescribed ULT (2010 and 2019) for gout management in Ontario, Canada. The study defined T2T success as achieving SUA levels <360 μmol/L (6 mg/dL) within 12 months of starting ULT. The evaluation of adherence to ULT was also performed. Multilevel logistic regression was used to analyze factors associated with achieving target SUA levels, clustering by ULT prescriber and including patient, physician, and prescription variables.

The result showed 44,438 patients (mean ± SD age 76.0 ± 7.3 years; 64.4% male), and only 30,057 (67.6%) patients had ≥1 SUA completed the test. Of the total, only 52.3% achieved the SUA target within 12 months, with improvements observed from 45.2% in 2010 to 61.2% in 2019 (P<0.0001). Adherence to ULT was found to be 55.3% and showed yearly improvement. Significant factors associated with achieving treatment-to-target (T2T) included febuxostat treatment (OR 11.40, 95% CI 5.10–25.43; administered to only 88 patients), adherence to ULT (OR 5.17, 95% CI 4.89–5.47), initial allopurinol doses >50 mg (OR 2.53, 95% CI 2.14–2.99), co-prescription of colchicine/oral glucocorticoids (OR 1.24, 95% CI 1.14–1.34), and ULT prescribed by a rheumatologist.

Investigator concluded that less than half of patients achieved optimal SUA levels within a year of treatment, despite improving medication adherence and higher starting doses, indicating a need for improved gout management strategies.

Source: acrjournals.onlinelibrary.wiley.com/doi/10.1002/acr.25380