Achievement of serum uric acid target by rheumatology clinic pharmacists compared with primary care providers in patients with gout

Abstract

BackgroundThe American College of Rheumatology strongly recommends a treat-to-target management strategy to achieve and maintain serum uric acid (sUA) less than 6 mg/dL to decrease risk of gouty flare recurrence and permanent joint damage. ObjectiveTo compare the effectiveness of rheumatology clinic pharmacists and primary care providers (PCPs) in achieving a target sUA goal in patients with gout. MethodsThis retrospective chart review included patients aged 18 years and older starting urate-lowering therapy (ULT) (allopurinol, febuxostat, or probenecid) for gout between January 1, 2015, and December 31, 2019. Exclusion criteria were ULT use within the previous 6 months, baseline sUA less than 6 mg/dL, and death within 12 months of starting ULT. From ULT initiation, data were collected until sUA less than 6 mg/dL was achieved or a maximum of 12 months. The primary outcome was the percentage of patients who achieved sUA less than 6 mg/dL. Key secondary outcomes were percent reduction in sUA and time to sUA target achievement. ResultsOf 62 patients included in each group, 75.8% of patients in the pharmacist cohort versus 30.6% of patients in the PCP cohort achieved target sUA less than 6 mg/dL (odds ratio 7.09, 95% confidence interval 3.28–16.11, P < 0.001). Patients in the pharmacist-managed group also achieved a greater reduction in mean sUA (−36.7% vs. −26.9% respectively, P = 0.001). Among patients achieving target sUA, median time to target was similar at 92 and 86 days, respectively, despite significantly lower initial mean allopurinol doses in the pharmacist-managed group (102 mg/d vs. 145 mg/d, P < 0.001). ConclusionThe odds of achieving target sUA within 12 months were 7 times higher if gout was managed by a rheumatology clinic pharmacist as compared with a PCP. This study suggests the need for prescriber education and supports expansion of pharmacist-led gout management to primary care settings.