Background/Purpose: Gout affects approximately 1-4% of the population in developed Western countries. The hallmark signs of gout are elevated serum uric acid (SUA) level, episodes of painful inflammatory arthritis (flares), and tophi. Despite treatment with urate lowering therapies (ULT), e.g., xanthine oxidase inhibitors, a significant proportion of patients continue to have elevated SUA, recurrent flares, or tophi. This study aimed to estimate the rate of gout control among ULT treated established gout patients in the United States (US), United Kingdom (UK), and Germany (DE).
Methods: A longitudinal panel study was conducted using IMS’ PharMetrics Plus database linked with outpatient laboratory results (US), Disease Analyzer (DE) databases, and the Clinical Practice Research Datalink-Hospital Episode Statistics (UK) from Jan 1, 2009 to Dec 31, 2011. Patients were required to have evidence of established gout (treated with ULT or eligible for ULT based on American College of Rheumatology guidelines) between Jan 1, 2009 and Dec 31, 2009; aged ≥18 years on index date (Jan 1, 2010); and have SUA results for outcome assessment at continuous follow-up in their respective databases throughout the observation period. ULT treatment was defined as having ≥60 days’ supply of consecutive therapy any time during the baseline period (calendar year 2010). Gout symptom control was defined as SUA <6 mg/dL, ≤1 flare, and no tophi, and was measured at any time during the outcome assessment period (calendar year 2011).
Results: A total of 1,765 (US), 3,594 (UK), and 17,486 (DE) patients met the patient selection criteria and the ULT treatment definition in the respective databases. The mean (SD) age of the patients was 54.5 (9.6), 64.6 (12.3), and 69.2 (11.0) years in the US, UK, and DE, respectively. Most patients were male (US: 89.2%; UK: 85.6%; DE: 70.3%). Of the comorbidities evaluated at baseline, hypertension and hyperlipidemia were the most common in the US (64.9% and 54.8%, respectively) and DE (73.8% and 54.0%, respectively), while hyperlipidemia (51.6%) was the most common in the UK. Overall, 40.9%, 49.6%, and 41.1% of patients treated with ULT in the US, UK, and DE, respectively, achieved gout symptom control. When baseline ULT treatment was evaluated among controlled and uncontrolled patients, allopurinol was the predominant treatment in all 3 countries (US: N=1,575; UK: N=3,466; DE: N=16,684). Of those treated with allopurinol in the respective databases, 43.6% (US), 51.2% (UK), and 41.5% (DE) were controlled patients. Fewer patients were treated with febuxostat (US: N=76; UK: N=15; DE: N=61); and of those treated with febuxostat in the respective databases, 39.5% (US), 33.3% (UK), and 36.1% (DE) were controlled patients.
Conclusion: Overall, less than half of patients treated with ULT achieved gout symptom control, with the vast majority of patients in this study treated with allopurinol. New treatment options might be needed to improve outcomes/gout control for some patients. Further investigation is also necessary to understand factors that impact gout symptom control among treated patients.
Disclosure:
R. Morlock,
Ardea Biosciences, Inc.,
1,
Ardea Biosciences, Inc.,
3;
C. Storgard,
Ardea Biosciences, Inc.,
1,
Ardea Biosciences, Inc.,
3;
V. F. Schabert,
IMS Health,
3;
A. Ogbonnaya,
IMS Health,
3;
P. Chevalier,
IMS Health,
3;
D. Hines,
IMS Health,
3;
S. Ramachandran,
AstraZeneca,
1,
AstraZeneca,
3.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluation-of-symptom-control-among-treated-gout-patients-in-the-united-states-united-kingdom-and-germany/