Chronic Refractory Gout Needs Better Management in US

People with chronic refractory gout (CRG) had elevated serum urate (SU) levels and high healthcare resource utilization (HRU) despite using urate-lowering medications in new real-world research, highlighting the need for better treatment and management strategies.1

“As the prevalence of gout continues to increase, there is a critical need for treatments that can achieve sustained SU reduction without tolerability concerns to effectively manage gout.2 Several promising agents are currently being investigated in clinical trials, but up-to-date information on the treatment strategy and burden associated with CRG is required. The present study evaluated the clinical profile, treatment patterns, and HRU of real-world patients with CRG in the US using claims data,” lead investigator Nana Kragh, Global Director of Health Economics and Outcomes Research, Sobi, Stockholm, Sweden, and colleagues wrote.1

Kragh and colleagues conducted a retrospective cohort study analyzing data from patients with CRG (≥ 3 flares within 18 months or a pegloticase prescription following gout diagnosis) between June 2011 and May 2020 in the IQVIA PharMetrics® Plus database linked with IQVIA Ambulatory Electronic Medical Records–US. They analyzed demographic, clinical, and disease characteristics, gout-related medications, and HRU for patients with SU levels ≥ 6.0 mg/dL at baseline and in the subset with elevated levels (≥ 2 measurements ≥ 6.0 mg/dL) over a 12-month follow-up period.

The investigators found that among 969 patients with CRG, 157 had elevated SU levels ≥ 6.0 mg/dL during follow-up. All patients had a high comorbidity burden. A high proportion of patients in the overall population (57.5%) and in the subset with elevated serum urate during follow-up (73.2%) were not seen to achieve SU level < 6.0 mg/dL at any point during follow-up, despite using gout-related medications including allopurinol.1

Overall, patients had a high use of steroids (overall, 77.0%; elevated SU, 79.6%) and nonsteroid anti-inflammatory drugs (overall, 59.3%; elevated SU, 59.9%) to manage gout flares. The investigators found that patients had high rates of gout-related HRU, including inpatient admissions (overall, 5.7%; elevated SU, 6.4%), emergency room visits (overall, 12.7%; elevated SU, 15.3%), and outpatient visits (overall, 96.8%; elevated SU, 100%). Notably, around one-third of participants (overall, 24.4%; elevated SU, 28.7%) used opioids during the follow-up period, indicating a significant amount of pain.1

Kragh and colleagues noted limitations of the study, including the method of identifying CRG and gout flares and other inherent limitations of claims-based studies, as well as only assessing a specific population of United States patients primarily with private insurance.

“In a large population of real-world patients with CRG in the US, recorded serum urate levels remained elevated in the majority of patients despite treatment. Patients had high use of pain and anti-inflammatory medications as well as health care resource use, reflecting the substantial burden of CRG on patients and the US healthcare system. These findings underscore the need for improved treatments and management strategies for CRG,” Kragh and colleagues concluded.1

REFERENCES

1. Kragh N, Worsfold A, Oladapo A, Gao E, Sethi S, Swallow E. Evaluation of Real-World Treatment Patterns and Healthcare Resource Utilization in Patients with Chronic Refractory Gout in the United States. Adv Ther. Published online May 8, 2025. doi:10.1007/s12325-025-03189-5

2. Cross M, Ong KL, Culbreth GT, et al. Global, regional, and national burden of gout, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2024;6(8):e507–17. https://doi.org/10.1016/S2665-9913(24)00117-6