POS0285 SUB-STANDARD CARE FOR PATIENTS WITH GOUT, DESPITE UPDATED GUIDELINES: A UK-WIDE, POPULATION-BASED COHORT STUDY

Abstract

BackgroundTreat-to-target urate-lowering therapy (ULT) is highly effective at preventing flares and improving quality of life for patients with gout.1 However, in 2012, only 27% of patients with gout in UK primary care received prescriptions for ULT within 12 months of diagnosis.2 Since then, EULAR and BSR gout management guidelines have been updated, to recommend that all patients with gout should have ULT discussed and offered to them, with uptitration of dosing until target urate levels are achieved. We investigated whether gout management has improved in recent years.ObjectivesTo assess temporal trends in the initiation of ULT and attainment of serum urate targets following new gout diagnoses in UK primary care from 2004 to 2020.MethodsThe Clinical Practice Research Datalink (CPRD) Gold database was used to assess the management of patients with index diagnostic codes for gout in UK primary care between January 2004 and October 2020. We analysed the proportion of patients with the following outcomes within 12 months of diagnosis: i) initiation of ULT (allopurinol, febuxostat, benzbromarone, probenecid or sulfinpyrazone); ii) serum urate ≤360 µmol/L; iii) serum urate ≤300 µmol/L; iv) treat-to-target urate monitoring (defined as two or more serum urate levels performed within 12 months of diagnosis and/or one or more urate ≤300 µmol/L). Interrupted time-series analyses (ITSA) were used to estimate the impact of updated EULAR and BSR gout management guidelines on these outcomes. Multivariate logistic regression was used to analyse predictors of ULT prescription and target attainment following new gout diagnoses.Results129,972 patients had index gout diagnoses between January 2004 and October 2020, of whom only 37,529 (28.9%) had ULT initiated within 12 months of diagnosis. ULT initiation improved modestly over the study period, from 26.8% for those diagnosed in 2004 to 36.6% in 2019, decreasing to 34.7% in 2020 (Figure 1). Of patients diagnosed in 2020 who had a serum urate performed within 12 months of diagnosis, 36.0% attained a urate ≤360 µmol/L, while 17.1% attained a urate ≤300 µmol/L. Of all participants, 18.9% received treat-to-target urate monitoring. In ITSA models, no statistically significant improvements in ULT prescription or urate target attainment were observed after publication of updated EULAR (2016) or BSR (2017) gout management guidelines, relative to before publication of these guidelines. In multivariate logistic regression models, comorbidities including chronic kidney disease, heart failure and obesity, and diuretic use were associated with increased odds of ULT initiation but decreased odds of attaining target urate levels by 12 months.Figure 1.Proportion of patients newly diagnosed with gout who: i) were initiated on urate-lowering therapy (ULT) within 12 months of diagnosis (black line); ii) had a serum urate performed and attained a level ≤360 µmol/L (light blue) or ≤300 µmol/L (dark blue) within 12 months of diagnosis.ConclusionIn this UK-wide study, we demonstrate that the initiation of ULT and attainment of serum urate targets following new gout diagnoses remain poor, despite the introduction of updated management guidelines. If the evidence-practice gap in gout management is to be bridged successfully, strategies to implement best practice gout care are urgently needed.