Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Although gout is a relatively common condition, treatment is often not ideal with many patients continuing to experience multiple flares and some developing complications associated with the disease. To improve patient care the American College of Rheumatology (ACR) recently proposed a draft set of recommendations for treating patients with gout. The purpose of this study is to assess the percentage of patients that meet the recently proposed treatment guidelines and the impact of following guideline recommendations on reaching serum uric acid (sUA) and flare targets.
Methods: Data were assessed from a quantitative survey of US physicians about gout disease management. Laboratory and clinical data were confirmed through chart audits using a structured case report form. The sample was restricted to patients treated with allopurinol or febuxostat. Xanthine oxidase (XO) inhibitor and initial dose, use of prophylactic medication, sUA level, physician type (rheumatologist vs. primary care physician [PCP]), patient socio-demographics factors, and flare rates (treatment and non-treatment related) were recorded/abstracted. Descriptive statistics were used to describe quality indicators consisting of the number of patients initiating XO inhibitor therapy with anti-inflammatory prophylaxis medication, titration of allopurinol and having multiple sUA assessments. A multivariate model was used to assess the impact of patient, clinician, and quality indicators on achieving sUA < 6 and < 1 flare over a 12-month period.
Results: The sample included 125 rheumatologists and 124 PCPs. Of the 1,245 patients with gout, 858 (69%) were treated with a XO inhibitor: 621 (72.4%) were treated with allopurinol and 237 (27.6%) were treated with febuxostat. Rheumatologists managed the care for 500 (58.3%) patients and PCPs managed the care for 358 (41.7%) patients. Anti-inflammatory prophylaxis treatment was used in 67% of cases treated by rheumatologists and only 37% of cases treated by PCPs. Multiple sUA assessments over a 12-month period were done in 68% and 53% of patients managed by rheumatologists and PCPs, respectively. Allopurinol dose was titrated above 300mg in 8% of patients treated by a PCP and 29% of patients treated by rheumatologists (p<0.01). Only 25% of patients obtained sUA < 6 and reported < 1 flare per year. Controlling for confounding factors, a multivariate model found quality indicators for the use of prophylaxis flare prevention at treatment initiation, multiple sUA assessments and physician type as predictive of achieving sUA and flare goals.
Conclusion: Only 25% of patients reach sUA < 6 and < 1 flare over a 12-month period. Adherence to draft ACR guidelines vary by physician type. Patients receiving guideline recommended care are more likely to achieve treatment goals, yet, significant opportunities exist to improve care for the majority patients regardless of physician specialty, including use of prophylactic treatment, dose titration of urate-lowering therapy and/or effective treatment strategies to bring patients to sUA goal and eliminating flares.
Disclosure:
J. A. Singh,
Research and travel grants from Takeda, Savient, Wyeth and Amgen,
2,
Honoraria from Abbott,
9,
Consultant fees from URL Pharma, Savient, Takeda, ArdeaBioscience, Allergan and Novartis.,
5;
D. Hagerty,
Ardea Bioscience,
3,
Ardea Bioscience,
1;
C. Storgard,
Ardea,
3,
Ardea,
1;
R. Mischler,
Adea Bioscience,
3,
Ardea Bioscience,
1;
R. Morlock,
Ardea Bioscience,
5.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/proposed-gout-treatment-guidelines-and-meeting-serum-urate-and-flare-goals/