Study Finds Limited Durability After Treat-to-Target ULT Interventions for Gout

New research has found that treat-to-target urate lowering therapy (ULT) interventions may have limited durability once patients return to real-world gout management, especially among underrepresented patient populations.1

“Though several reports have demonstrated suboptimal rates of adherence and/or persistence with ULT using real-world data, the use of ULT in real-world healthcare settings has consistently been demonstrated to fall short of best practices in gout management endorsed by international guidelines and supported by high-quality trial data. Few studies, for example, have examined the durability of real-world ULT following treat-to-target implementation. The frequency of long-term persistence following the implementation of highly effective ULT is largely unknown,” lead investigator Samantha Kohn, MD, Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, United States, and colleagues wrote.1

Kohn and colleagues analyzed data from 638 participants completing the 72-week STOP Gout trial with 2 years of follow-up data post-study. Follow-up data consisted of passive administrative and electronic health record data with persistence defined by a ULT dispensing episode overlapping with the 2-year post-study time point. The investigators also examined associations of participant factors with ULT persistence using multivariable logistic regression.

Study participants were predominantly male (99 %) and had a mean age of 62.7 years. At 2-years post-study, 66% continued ULT. Kohn and colleagues found that after adjusting for covariates, at least 2 rheumatology visits post-study was associated with greater ULT persistence (adjusted odds ratio [aOR], 1.75; 95% CI, 1.13–2.72) than no visits. Notably, ULT persistence was lower in those that reported Black/African American race (aOR, 0.56; 95% CI, 0.36–0.87), Hispanic ethnicity (aOR, 0.21; 95% CI, 0.09–0.50), and better quality-of-life at the beginning of post-study follow-up. Investigators did observe a trend of achievement of serum urate goal at 48-weeks during the STOP Gout study being associated association with greater long-term persistence (aOR 1.68; 95 % CI 0.99–2.85), although this did not reach significance.1

“Though interventions implementing treat-to-target ULT have demonstrated efficacy in trials, this study suggests that such interventions may have limited durability following transitions back to real-world gout management. The issue of limited treatment durability appears to be compounded among underrepresented patient populations and improved in the context of ongoing rheumatological care,” Kohn and colleagues wrote.1

Other recent research into that treat-to-target ULT interventions led by Till Uhlig, Dr. Med, professor, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway, and University of Oslo, Faculty of Medicine, Norway found that while overall adherence to urate lowering therapy (ULT) was high, non-adherence was associated with more flares and less urate target achievement in people with gout.2

The findings were from 163 patients in the NOR-Gout observational study that had a recent gout flare and serum urate levels over 360 µmol/L. Patients had a mean age of 56.2 years (standard deviation, 13.6), most were male (94.5%), and 17.2% had tophi. Participants attended tight-control visits for 1 year with escalating ULT using a treat-to-target strategy. Over 5-year follow-up, participants completed the Medication Adherence Report Scale (MARS-5) questionnaire (range 5-25) for assessing adherence. Investigators compared flares and serum UA target achievement for 5-year adherence to medication.2

Investigators found that at 5 years, most patients used ULT (95.1%). Overall, MARS-5 adherence scores were high (median, 24; interquartile range, 22-25). Patients in the lowest MARS-5 quartile had, compared to the highest quartile,flares more often during the last year of follow-up (33.3% vs. 9.5%, P =.004), and reached the 5-year serum urate treatment target less frequently (45.2% vs. 87.5%, P <.001).2

They found that baseline lower age (odds ratio [OR}, 0.56 [95%CI, 0.39-0.79]), non-European origin (OR, 0.22 [95%CI, 0.06-0.80]), lower SF-36 mental health scores (OR, 0.94 [95%CI, 0.91-0.98]) and less joint pain during last flare (OR, 0.73 [95%CI, 0.58-0.92]) were independent risk factors for non-adherence to medication.2

“In summary, adherence to medication was in our study high after 5 years, and nonadherence was related to poor gout outcomes. Findings underscore that caregivers should address variables associated with non-adherence early during ULT and provide additional care to support adherence in those at risk of non-adherence,” Uhlig and colleagues concluded.2

REFERENCES

1. Kohn S, Sayles H, Helget LN, et al. Real-World Persistence of Urate-Lowering Therapy Following a Treat-to-Target Intervention: a Two-Year Follow-Up Analysis of the STOP Gout Trial. Seminars in Arthritis and Rheumatism. Published online August 1, 2025:152800-152800. doi: 10.1016/j.semarthrit.2025.152800

2. ‌ Uhlig T, Karoliussen LF, Sexton J, et al.Non-adherence to urate lowering therapy in gout after 5 years is related to poor outcomes—results from the NOR-Gout study, Rheumatology. Published online September 18,2024;keae514. Doi: 10.1093/rheumatology/keae514