Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Study patterns of gout treatment and related outcomes in US community rheumatology practices, specifically the relation between likelihood and severity of gout flares, time in treatment with current physician, serum uric acid (sUA) level and urate lowering therapy (ULT, which included, at any dosage level, allopurinol, febuxostat, pegloticase, probenecid).
Methods: Fifty practices completed retrospective chart abstraction on their 25 most recently seen patients with gout. Data, abstracted from all visits in 2010-2011 using standardized case report forms, included demographics, gout history, co-morbidities, sUA, gout treatment, and visit type (flare-related or follow-up). This report includes all data from the subset of the total cohort which was available at time of abstract submission. Final dataset will comprise 1,250 patients.
Data were analyzed using logistic regression, with visit type (coded as severe flare, mild/moderate flare, non-flare related) as an ordinal response variable, and 3 predictor variables: time in treatment with current rheumatologist at start of chart abstraction (TxTime: new patient vs. ≥ 2 months), ULT (absence vs. presence at time of visit) and sUA (≥ 6.0 vs. < 6.0).
Results: The study population consisted of 479 gout patients from 21 sites, 79% male, 77% Caucasian, mean age 62 years, median disease duration 5.5 years.
Patients had a total of 2,460 visits during study period. Of these, 1,465 (59.6%) included all analysis variables and constitute the analysis sample. 273 (18.6%) of visits were flare-related. All 3 main effects were significant. Increased likelihood of a flare was associated with 1) shorter TxTime, 2) absence of ULT, and 3) higher sUA. Data are summarized in the table.
|
|
|
|
Type of Visit (%) |
Any Flare vs. Non-Flare p-value OR (95% CI) |
||
|
|
|
n |
Flare-Related: Severe |
Flare-Related: Mild/Moderate |
Not Flare-Related |
|
|
TxTime |
New Pt. |
565 |
9.6 |
16.6 |
73.8 |
< .001 1.62 (1.22-2.15) |
|
> 2 mos. |
900 |
5.2 |
8.7 |
86.1 |
||
|
ULT |
Absent |
277 |
18.1 |
29.2 |
52.7 |
< .001 4.79 (3.52-6.52) |
|
Present |
1188 |
4.3 |
7.7 |
88.0 |
||
|
sUA |
≥ 6.0 |
729 |
9.9 |
15.9 |
74.2 |
.004 1.64 (1.21-2.22) |
|
< 6.0 |
736 |
3.9 |
7.6 |
88.5 |
||
The only significant interaction effect was ULT by TxTime (p < .01). Patients who were already on ULT when referred to the current rheumatologist were no more likely to flare than the physician’s current ULT patients. For patients not on ULT, however, new patients had triple the odds of flaring compared with current patients (OR=3.04, 95%CI=1.86-4.95).
Conclusion: Data depict aspects of current usage of gout therapy in US community practices and underscore importance of managing sUA levels. All patients regardless of sUA levels or treatment had some risk of flare, but risk was greatly mitigated by ULT therapy. These data suggest that failure to treat hyperuricemia in gout patients is associated with a greatly increased likelihood of a flare.
Disclosure:
M. I. Hamburger,
Savient Pharmaceuticals, Inc.,
5,
Amgen,
5,
Human Genome Sciences, Inc.,
5;
J. R. Tesser,
Savient Pharmaceuticals, Inc.,
5;
J. L. Skosey,
Savient Pharmaceuticals, Inc.,
5;
A. H. Morton,
Pfizer Inc,
5,
Amgen,
5,
URL Pharma, Inc.,
5,
Bristol-Myers Squibb,
5,
Savient Pharmaceuticals, Inc.,
5,
Novartis Pharmaceutical Corporation,
5,
Pfizer Inc,
8,
Amgen,
8,
UCB S.A.,
8,
URL Pharma, Inc.,
8,
Bristol-Myers Squibb,
8,
Takeda Pharmaceuticals USA, Inc.,
8,
Genentech and Biogen IDEC Inc.,
8,
Abbott Laboratories,
8,
Warner Chilcott plc,
8,
Savient Pharmaceuticals, Inc.,
8;
K. M. Kilgore,
Savient Pharmaceuticals, Inc.,
5.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patterns-of-gout-treatment-and-related-outcomes-in-us-community-rheumatology-practices-the-relation-between-gout-flares-time-in-treatment-serum-uric-acid-level-an/