Does T2T Lead to Fewer Gout Flares? Save

Lancet Rheumatology reports that a treat-to-target (T2T) goal of average serum urate less than 6 mg/dL is associated with an absence of gout flares and a reduction in the number of flares in the next 12 months.

While the 2017 American College of Physicians gout treatment guidelines advocate for T2T use of urate lowering agents, the American College of Physicians have disregarded the need for T2T in management. This study assessed the relationship between achieving target serum urate and the occurrence of gout flares.

Patient -level data was drawn from two randomised trials on urate-lowering therapies in people with gout conducted in Nottingham, UK, and New Zealand.

Those who achieved a serum urate < 6 mg/dL (0·36 mmol/L) were defined as serum urate responders and those over would be nonresponders. The primary outcome was the proportion gout flares, and the secondary outcome was the mean number of flares per participant per month, from 12 to 24 months.

Patients from both trials were classified as 343 serum urate responders and 245 serum urate non-responders.

There were significantly fewer gout flares in the responders than non-responders between 12 and 24 months (27% vs 64%[OR 0·29; 95% CI 0·17 to 0·51], p<0·0001).

Achieving T2T (serum urate < 6 mg/dL) is clearly associated with fewer gout flares in the ensuing months in those with gout.

These data strongly support a treat-to-target serum urate approach in the management of gout.