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Data presented at EULAR 2023 details the factors that matter most to patients with gout when considering the continuation or discontinuation of urate-lowering therapy after achieving clinical remission.
A pair of substudies presented at the European Congress of Rheumatology (EULAR) 2023 annual meeting is providing clinicians with a snapshot of patient perspective on the continuation or discontinuation of urate-lowering therapy when gout remission has been achieved.
With perspective from more than 170 patients, results of the study suggest the greatest item of concern when making the decision to discontinue orate-lowering therapy among patients was related to control of disease activity rather than costs, logistics, or physical monitoring.1
“We aim to lower serum urate below a certain level and for patients to be free of gout flares and tophi—that's the goal. But when a patient achieves that goal, they often ask, ‘Well, how long do I have to take this medication?’, and our advice is to take those medication lifelong, but the evidence supporting that is really very minimal,” explained study investigator Noortje van Herwaarden, MD, PhD, rheumatologist and clinical pharmacologist, Radboud University Medical Center, during an interview with HCPLive at EULAR 2023.
With recent estimates indicating an overall prevalence of 5.1% among the US population, the growing burden of gout could pose a significant burden to health systems in the future.2 Still, advances in management and therapies have allowed many patients to achieve remission. With this in mind, van Herwaarden and investigators from institutions in Holland designed their research endeavor with a mixed methods design.1
Specifically, investigators designed a pair substudies with substudy 1 aimed at identifying barriers and facilitators for discontinuation and continuation of urate-lowering therapy and substudy 2 aimed at ranking these factors and determine their relative importance based on preference scores which was calculated as a rescaled probability score (RPS). When creating their study cohorts, investigators recruited patients for both studies from general practitioners and from the rheumatology department of the Saint Maartens Medical Clinic in Holland.1
The first substudy included 18 patients. This cohort had a mean age of 67 (SD, 9) years, 89% were male, the median disease duration was 8.4 (SD, 6) years, and 78% reported currently or previously receiving care from a rheumatologist. The second substudy included 156 patients. This cohort had mean age of 66 (SD, 10) years, 94% were male, the median disease duration was 10 (SD, 6) years, and 85% reported currently or previously receiving care from a rheumatologist.1
The semi-structured interviews led to the identification of 46 barriers or facilitators. These were summarized into 22 items and divided into 10 themes. These 10 themes were as follows: logistics, lifestyle, role of serum urate, physician role, scientific knowledge, general medication use, anti-inflammatory use, gout flares, urate-lowering therapy use, and long-term gout effects. In the second substudy, investigators identified the ranking of each of the 22 items identified in substudy 1. After ranking, risk of joint damage (RPS, 8.77) was identified as the most important item among patients with gout when considering discontinuation of urate-lowering therapy, with investigators highlighting risk of joint damage was 26 times more important than the least important item among patients, which was the cost of gout treatment (RPS, 0.34).1
“What we saw is that patients think disease activity and outcomes are important and they care a bit less about the cost and the logistics of taking the medication,” van Herwaarden added. “And it's important if a patient ask questions about long term urate-lowering therapy that you discuss these so you know which items are important for patients.”