Session Type: Poster Session (Tuesday)
Session Time: 9:00AM-11:00AM
Background/Purpose: The number of gout attacks can be reduced by achieving and maintaining serum uric acid (sUA) at or below 6.0 mg/dL, a level uniformly recommended by international guidelines. However, although urate-lowering therapy (ULT) can reliably achieve such reductions, many gout patients fail to reach their sUA target, and such patients tend to experience recurring gouty arthritis in real-world clinical practice. The present study assessed factors related to achieving target sUA levels and the occurrence of gouty arthritis in Japanese clinical practice, to better understand the underlying reasons for suboptimal treatment of gout.
Methods: We analyzed Japanese health insurance claims and medical check-up data from April 2016 to March 2017, and assessed factors that were associated with target sUA in gout and asymptomatic hyperuricemia and with the occurrence of gouty arthritis in gout. We also conducted subgroup analysis of ULT prescriptions and outcomes, stratified by renal function, to determine effects on achieving target sUA. Data were obtained from the JMDC Claims Database, including diagnostic codes, names of prescription drugs prescribed, and data from physical examinations of company employees and their dependents.
Results: Patients who reached their target sUA tended to be older, to be female, to receive higher doses of ULT, to achieve higher treatment adherence ( medication possession ratio), to have more comorbidities, and/or to be prescribed antidiabetic drugs. We found that renal dysfunction and/or diuretic prescriptions were predictive of reduced achievement of target sUA. This was obvious in severe renal dysfunction (OR 0.22 [95% CI 0.10-0.48] for < 15 and 0.15 [0.10-0.23] for ≥15 to < 30, compared with eGFR ≥90 mL/min/1.73m2) (Figure 1). Notably, the mean prescribed ULT dose was low (febuxostat 17.0-21.0 mg/day, allopurinol 123.1-139.6 mg/day) a cross all renal function categories. We also found that lower renal function was associated with lower achievement of target sUA for every ULT dosage category. Our data showed that gouty arthritis attacks occurred more often among patients with a prior history of gouty arthritis and less often in patients who had higher ULT adherence, sUA measured at medical facilities, and/or more comorbidities (Figure 2).
Conclusion: Our analysis showed renal dysfunction as an important predictor for failure to achieve target sUA; within our dataset, most renal dysfunction patients with gout or asymptomatic hyperuricemia did not reach target sUA. These findings imply suboptimal disease management, especially in this population. Our findings also suggested the importance of regular clinic visits and sustained adherence to ULT in the control of gouty arthritis attacks.
To cite this abstract in AMA style:Koto R, Nakajima A, Horiuchi H, Yamanaka H. Factors in Achieving Serum Uric Acid Target and the Occurrence of Gouty Arthritis: A Cross-sectional Study Based on Japanese Health Insurance Claim Data [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/factors-in-achieving-serum-uric-acid-target-and-the-occurrence-of-gouty-arthritis-a-cross-sectional-study-based-on-japanese-health-insurance-claim-data/. Accessed June 1, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-in-achieving-serum-uric-acid-target-and-the-occurrence-of-gouty-arthritis-a-cross-sectional-study-based-on-japanese-health-insurance-claim-data/