ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 0655

Weight Loss as Treatment for Gout in Patients with Concomitant Obesity: A Proof-of-Concept Randomized Controlled Trial

Kristian Zobbe1, Robin Christensen2, Sabrina Mai Nielsen3, Lisa Stamp4, Marius Henriksen5, Anders Føhrby Overgaard6, Lene Dreyer7, Filip Krag Knop8, Jasvinder Singh9, Michael Doherty10, Pascal Richette11, Arne Astrup12, Karen Ellegaard1, Else Marie Bartels13, Mikael Boesen14, Henrik Rindel Gudbergsen15, Henning Bliddal15 and Lars Erik Kristensen16, 1The Parker Institute - Frederiksberg og Bispebjerg Hospitaler, Copenhagen, Denmark, 2Musculoskeletal Statistics Unit, The Parker Institute/Odense University Hospital, Copenhagen F, Denmark, 3The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark, Frederiksberg, Denmark, 4University of Otago Christchurch, Christchurch, New Zealand, 5The Parker Institute - Frederiksberg og Bispebjerg Hospitaler, Copenhagen, 6The Parker Institute - Frederiksberg og Bispebjerg Hospitaler, Sorø, 7Department of Rheumatology, Aalborg UnIversity Hospital, Aalborg, Denmark, 8Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark, Copenhagen, 9University of Alabama at Birmingham, Birmingham, AL, 10Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham UK, Nottingham, United Kingdom, 11Department of Rheumatology, Lariboisière Hospital, Paris, France, 12Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark, Copenhagen, Denmark, 13Department of Neurology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark, Copenhagen, Denmark, 14Department of Radiology Copenhagen University hospital Bispebjerg and Frederiksberg; The Parker Institute, Copenhagen, Denmark, 15The Parker Institute - Frederiksberg og Bispebjerg Hospitaler, Frederiksberg, Denmark, 16The Parker Institute Copenhagen Denmark, Copenhagen, Denmark, Bispebjerg and Frederiksberg, Denmark

Meeting: ACR Convergence 2020

Keywords: , ,

Session Information

Date: Saturday, November 7, 2020

Session Title: Metabolic & Crystal Arthropathies Poster

Session Type: Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Despite scarce evidence regarding the effects of weight loss in gout1, international guidelines recommend dietary advice and weight loss as a core management strategy in people with gout and concomitant obesity. We explored whether there are potential clinical benefits associated with intensive weight loss in obese individuals with gout.

Objectives:

To compare in a proof-of-concept randomized trial the effect of an intensive, 16-weeks weight loss program (full meal replacement with hypocaloric products and weekly visits to a dietician), relative to a dietary advised control group (ordinary food and visits to a dietician only at baseline and at week 8), on primarily changes in body weight and secondarily serum urate, fatigue and pain in people with gout and concomitant obesity.

Methods: Participants were randomized using permuted blocks and stratification (i.e. sex (male vs. female), obesity (BMI< 40kg/m2 vs BMI≥40kg/m2), serum urate (< 6mg/dL vs ≥6mg/dL)). he primary outcome was change in body weight at 16 weeks, analyzed using repeated measures mixed models. According to the Statistical Analysis Plan, the key secondary outcomes were changes in serum urate, VAS gout pain, and VAS fatigue after 16 weeks. ClinicalTrials.gov (NCT03664167).

Results: Overall, 61 participants were enrolled and randomized, of whom 29 were assigned to intensive weight loss and 32 to dietary control. The participants had an average age of 60.3 (SD, 9.9) years, average BMI of 35.6 (SD, 5.0) kg/m2 and 59 (97%) were men. There was a statistically and clinically significant difference in the change in body weight from baseline to 16 weeks between the dietary and control groups (least squares means: -15.4 kg and -7.7 kg, respectively; difference: -7.7 kg (95%CI -10.9 to -4.7, p< 0.001). Mean changes in serum urate levels at the 16 weeks visit were -0.6 mg/dL and -0.3 mg/dL, respectively, with a difference between groups of -0.3 mg/dL (95%CI -0.9 to 0.3, p=0.744). The corresponding mean change in VAS fatigue was -17.4 mm compared to -8.6 mm, with a group difference of -8.8 mm (95%CI -25.5 to 7.9). Mean change in VAS pain corresponded to -2.5 mm compared to -12.5 mm, with a group difference of 9.9 mm (95% CI -11.1 to 31.0).

Conclusion: An intensive dietary intervention can effectively lower body weight in people with gout and concomitant obesity. Although absolute differences were present, we were not able to reject the null hypotheses for serum urate, fatigue, and pain in this proof-of-concept study with a small sample size

 1  Nielsen SM, Bartels EM, Henriksen M, et al. Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies. Ann Rheum Dis. 2017. doi:10.1136/annrheumdis-2017-211472

Figure A: Effect of diet on weight B: Effect of diet on serum urate. Open dots = control group, Closed dots = intensive diet.

Disclosure: K. Zobbe, None; R. Christensen, None; S. Nielsen, None; L. Stamp, None; M. Henriksen, None; A. Overgaard, None; L. Dreyer, BMS, 2, Janssen pharmaceuticals, 5, Eli Lilly, 8, UCB, 8, MSD, 8; F. Knop, None; J. Singh, Crealta/Horizon, 1, Medisys, 1, Fidia, 1, UBM LLC, 1, Trio health, 1, Medscape, 1, WebMD, 1, Clinical Care options, 1, Clearview healthcare partners, 1, Putnam associates, 1, Focus forward, 1, Navigant consulting, 1, Spherix, 1, Practice Point communications, 1, the National Institutes of Health, 1, the American College of Rheumatology, 1, Amarin pharmaceuticals, 1, Viking therapeutics, 1, OMERACT, 1; M. Doherty, None; P. Richette, AbbVie Inc., 1, Biogen, 1, Janssen, 1, BMS, 1, Roche, 1, Pfizer, 1, Amgen, 1, Sanofi-Aventis, 1, UCB, 1, Lilly, 1, Novartis, 1, Celgene, 1; A. Astrup, None; K. Ellegaard, None; E. Bartels, None; M. Boesen, IAG, 5, Abbvie, 5, Eli Lilly, 5, Esaote, 5, Siemens, 5, Celgene, 5, UCB, 5, Roche Pfizer, 5, Astra Zeneca, 5, Takeda, 5, Rottapharm, 5; H. Gudbergsen, None; H. Bliddal, None; L. Kristensen, AbbVie, 2, 8, Amgen Inc., 2, 8, Biogen, 2, 8, BMS, 2, 8, Eli Lilly, 2, 8, Janssen, 2, 8, Novartis, 2, 8, Pfizer, 2, 8, UCB Pharma, 2, 8, Sanofi, 2, 5, 8.

To cite this abstract in AMA style:

Zobbe K, Christensen R, Nielsen S, Stamp L, Henriksen M, Overgaard A, Dreyer L, Knop F, Singh J, Doherty M, Richette P, Astrup A, Ellegaard K, Bartels E, Boesen M, Gudbergsen H, Bliddal H, Kristensen L. Weight Loss as Treatment for Gout in Patients with Concomitant Obesity: A Proof-of-Concept Randomized Controlled Trial [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/weight-loss-as-treatment-for-gout-in-patients-with-concomitant-obesity-a-proof-of-concept-randomized-controlled-trial/. Accessed November 30, 2020.

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