Background/Purpose: Diuretics have been associated with impaired response to allopurinol and refractoriness in gout, but whether this stills after new urate-lowering treatments (ULT) and treat-to-target strategies is unknown. The aim of this study was to assess the impact of the diuretic therapy on the response to ULT in patients with gout.

Methods: Retrospective analysis of an inception cohort of patients with crystal-proven gout (Jan2014-Nov2016). Patients were classified according to the type of ULT received and whether they were on diuretics (loop and/or thiazide) at baseline. The last visit of follow-up was registered. The primary outcome variables were a) reduction of serum uric acid (SUA) levels from baseline; b) achievement of different SUA targets (6, 5, and 4mg/dL); and c) maximum dose of ULT employed. Clinical, laboratory and ULT-related variables were also registered. A comparative analysis was performed according to the use of diuretics, using Student’s t and chi-2 tests, stratified by the type of ULT prescribed. Also, to properly determine the influence of diuretics on gout management (maximum dose of ULT used), a multiple linear regression model was built.

Results: The inception cohort included 225 patients with an average age of 65 years (SD 14.1), 86.2% of them men, with a median duration of gout at inclusion of 4 years (p25-75 1-10) and tophi in 21.3%. Follow-up data was available from 209 patients (92.9%), with a median 9 months of follow-up (4-14). A total of 98 patients (43.6%) were on diuretics, mainly for hypertension (64.7%), heart failure (9.4%), and renal failure (5.9%). These patients were older (p<0.001), had higher rates of females (p<0.001), hypertension (p<0.001), diabetes (p=0.001), and cardiovascular disease (p<0.001), and showed higher SUA (p=0.003) and lower glomerular filtration rate (p<0.001), compared to those not on diuretics. ULT used was allopurinol in 172 patients (82.6%) and febuxostat in 34 (16.5%) – benzbromarone was excluded due to minimal use (two cases). The table shows the outcome comparison according to diuretic treatment, stratified by type of ULT. Except for a lower achievement of SUA<5 in the allopurinol subgroup, no significant differences were found in SUA reduction and targets. Contrary to febuxostat, a trend to lower maximum dose of allopurinol in those on diuretics was noted, also in the bivariate analysis (β=-37.9, p=0.053, R²=0.022); however, this association was lost after multivariate adjustment for baseline characteristics (β=-18.1, p=0.499).

Conclusion: Despite its common use, diuretics currently show no significant impact on the achievement of treatment outcomes in patients with gout.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-diuretics-on-urate-lowering-therapy-in-patients-with-gout-analysis-of-an-inception-cohort/