A comparative study of real‐life management strategies in gout: data from two protocolized gout clinics

OBJECTIVE: To compare outcomes of two gout clinics that implemented a different treatment strategy. One clinic adopted a strict serum uric acid (sUA) (≤0.30 mmol/L) target (UA-) strategy - with early addition of uricosuric to allopurinol - and the other a patient-centred (PC-) strategy emphasizing shared decision based on sUA and patient satisfaction with gout control. METHODS: Patients newly diagnosed with gout and a follow-up of 9-15 months were included. Co-primary outcomes were proportion of patients reaching a sUA ≤0.36 mmol/L, and free of flares. Secondary outcomes were proportion of patients requiring treatment intensification, and experiencing adverse events. Independent t-tests or chi-square were used to test differences in outcomes, and logistic regressions to adjust the effect of centre on outcomes for confounders. RESULTS: In total, 126 and 86 patients had a follow-up of 11.3±1.8 vs 11.1±1.9 months. In the UA-strategy 105/126 (83%) compared to 63/86 (74%) patients in the PC-strategy (p=0.10), reached the threshold of ≤0.36 mmol/L; and 58/126 (46%) vs 31/86 (36%) were free of flares (p=0.15). In the UA-strategy 76/126 (60%) patients were on allopurinol monotherapy compared to 63/86 (73%) in the PC-strategy (p=0.05), yet the number of adverse events was not different (n=25 (20%) vs n=20 (23%), p=0.55). Adjusting for confounders did not substantially change these associations. CONCLUSION: A strict UA-strategy resulted in a non-significant higher proportion of patients reaching a sUA ≤0.36 mmol/L and being free of flares. This was accomplished with significantly more therapy intensification. The small sample-size plays a role in significance of results. This article is protected by copyright. All rights reserved.