Gout Review From EULAR2020 - Dr. Olga Petryna Save

Hello everyone. This is Olga Petrina and I'm here to share some updates from the virtual EULAR twenty twenty Congress. Today I would like to speak about studies and abstracts presented in the field of gout management and disease course. There are several abstracts that draw my attention and one of the abstracts is OP-one 169 which is the national database study. It's a claims database from The U.

S. Including 190,000,000 patients. In this database analysis patients were divided in four groups. First group were patients with gout and diabetes, second group patients with diabetes alone without gout, third group gout alone and of course the fourth group was the control group with neither of the conditions. And in this analysis it was shown that patients with both conditions at the same time had the highest rate of amputations at zero point seven seven percent followed by diabetes alone at zero point four six one percent.

Gout alone had the lowest rate of the three with zero point one six two but even with that they had threefold higher rate of amputations comparing to patients with none of the conditions. It only emphasizes that gout on its own is a dangerous condition and when it's occurring together with diabetes it can put patient at a great danger and of course it requires a very strict serum uric acid control in patients who have both conditions and aggressive treatment. Second poster I would like to talk about is OP-one 168, which is a population based study from Korean National Health Insurance Service and this database includes patients from twenty twelve-twenty eighteen and the goal of the study was to evaluate the risk of cardiovascular events in patients who were treated with febuxostat or allopurinol. The purpose of the study was to see if the rates are higher for either of the medications and mostly because earlier several years ago CARAS trial showed that patients who were treated with febuxostat tend to have a higher incidence rate of cardiovascular events. So re evaluation of the CARAS trial showed that actually increased cardiovascular events happen after stopping febuxostat and allopurinol abruptly and the speculation was that possibly the abrupt change of serum uric acid could be contributing or even cardiovascular gout attacks could be the cause as some of the CT scans of the patients showed the position of crystals of uric acid in the coronary arteries.

So, in this particular study from Korean national database, researchers found that both febuxostat and allopurinol were associated with higher incidence rate of myocardial infarction with higher incidence rate of cardiovascular as well as cerebral incidence, both ischemic and hemorrhagic strokes. The researchers in the study concluded that it most likely is not the medication per se but rather again the change of serum uric acid concentration or even so called cardiovascular gout attacks that are leading to this increased incidence of cardiovascular death and it was based on the fact that most of the allopurinol febuxostat treatment are started usually a week or two after acute gout attack. So this abrupt change of concentration of uric acid again is considered an actual risk factor. I think it's an interesting information and worth further investigation. And then the last abstract I would like to talk about is OP0205, which updates on phase one study of a novel Urate one inhibitor DO120.

This is the study of healthy adults and in this study patients were given novel Urate inhibitor alone and in combination with febuxostat and after fourteen day treatment it was considered to be safe. There was no serious adverse events. It was shown that it was well tolerated in a dose up to twenty milligram and it led to significant decrease of serum uric acid level four to eight hours after administration and the effect lasted at least twenty four hours, as well as the cumulative reduction of uric acid continued over seven days. From the side effects, the most common were drowsiness, there's one grade one increase in creatinine levels and abdominal discomfort but no major serious adverse events. So it's a potential therapeutic target and it's worth continuing studies in this field.

There's a lot more going on in this Congress and if you would like to hear more about gout abstracts or any other studies, please follow us on RheumNow. Thank you and have a good day.