For patients with gout, urate-lowering therapy (ULT) increases the risk for hospitalizations within the first 6 months of therapy, but reduces the risk in the long-term, according to Mark D. Russell, MD.
This is especially the case when serum urate targets are achieved, he noted.
Between 2006 and 2020, “hospital admissions due to gout have increased markedly, yet few studies have examined how to reduce avoidable admissions,” Dr. Russell explained. “Our study highlights the importance of urate-lowering medications for the long-term prevention of hospital admissions due to gout. We found that the admission prevention effects of [ULT] are greater when serum urate targets are achieved. This emphasizes the importance of a treat-to-target approach when managing patients with gout.”
Assessing Pattern and Frequency of Hospitalizations
Previous research used aggregated health data to show major increases in hospitalizations for gout over the past 20 to 30 years. According to Dr. Russell, this is the first study to utilize individual-level, linked primary and secondary care data to assess the pattern and frequency of hospitalizations in a nationwide cohort of patients with gout.
For a study published in Rheumatology, Dr. Russell and colleagues explored the correlations between hospitalization and treat-to-target ULT for gout. The researchers described the prevalence and timing of hospitalizations using linked Clinical Practice Research Datalink and NHS Digital Hospital Episode Statistics data in people with index gout diagnoses from 2004- 2020. They assessed links between ULT initiation, colchicine prophylaxis, reaching serum urate targets, and the risk for hospitalizations for gout by using propensity models and Cox proportional hazards.
The study team examined two primary objectives:
1) the effect of ULT, with and without colchicine prophylaxis, on the risk for hospitalizations; and
2) whether reaching target serum urate levels impact the risk for hospitalizations following the initiation of ULT.
Minority of Patients Met Serum Urate Targets Within 1 Year of Discharge
Among 292,270 patients with incident gout, 2.64% had one or more hospitalizations for gout flares, for an incidence rate of 4.64 hospitalizations per 1,000 person-years (95% CI, 4.54-4.73; Figure). When compared with patients who did not initiate ULT, there was an associated greater risk for hospitalizations within the first 6 months after ULT initiation (adjusted HR, 4.54; 95% CI, 3.70-5.58; P<0.001). Between patients prescribed versus not prescribed colchicine prophylaxis, hospitalizations did not differ significantly in fully adjusted models.
ULT was linked with a reduced risk for hospitalizations from 12 months after initiation (aHR, 0.77; 95% CI, 0.71-0.83; P<0.001). In ULT initiators, serum urate less than 360 micromol/l within 12 months of starting therapy was linked with a reduced risk for hospitalizations (aHR, 0.57; 95% CI, 0.49-0.67; P<0.001) when compared with patients starting ULT but not reaching this target.
In patients with gout, the prescription of ULT “associates with an increased risk [for] hospitalizations for flares within the first 6 months of initiation, but reduces hospitalizations from 12 months onwards, particularly when serum urate targets are achieved,” the study authors wrote. “Despite this, only a third of patients achieved serum urate targets within a year of discharge from hospital, and 40% remained on no ULT.”
The study team concurs that treat-to-target ULT must be applied if avoidable admissions are to be prevented in the long term.