Treat-to-Target and Cardiovascular Benefits in Gout Save
An emulated target trial, new user cohort study of 109 504 gout patients, achieving a serum urate level less than 6 mg/dL was associated with a significantly lower risk of cardiovascular events.
While rheumatology guidelines strongly advocate for a treat to target (T2T) in gout management, this is not advised by the American College of Physicians, whose stance limits the importance of routine serum uric acid (SUA) testing. Moreover, the consequences of T2T in gout have not been fully investigated. This trial assesses whether cardiovascular risk is altered when achieving a target serum urate level lower than 6 mg/dL with urate-lowering treatment (ULT).
Fiver year primary care data, from the Clinical Practice Research Datalink Aurum, was used to assess the impact of ULT and T2T on hospitalization and mortality (2007 to 2021). The study included adults with gout and a pretreatment SUA higher than 6 mg/dL, and were begun on a newly prescribed ULT. The primary outcome was first major adverse cardiovascular event within 5 years of first ULT prescription. Gout flare was the positive control outcome.
The study included 109 504 gout patients with a mean age 63 years (78% males), with a mean disease duration of 2.5 (3.6) years. The T2T ULT arm was 27.3% of the total cohort.
Patients in the T2T ULT arm had a higher 5-year survivaland a lower risk of major adverse cardiovascular events (weighted HR, 0.91; 95% CI, 0.89-0.92) compared to the non–T2T ULT arm. These results were enhanced in tos with high and very high cardiovascular risk.
Achieving a serum urate target of less than 5 mg/dL had aeven larger risk reduction (weighted survival difference, 2.6%; 95% CI, 0.9%-3.6%; weighted HR, 0.77; 95% CI, 0.72-0.81).
Patients in the T2T ULT arm had fewer gout flares.
Gout patients given a newly prescribed ULT, and who achieved SUA levels lower than 6 mg/dL within 12 months had a lower 5-year risk of major adverse cardiovascular events.
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