In this randomized controlled trial, people with gout and serum urate concentrations ≥6.8 mg/dL (0.40 mmol/L) were randomized to receive allopurinol, titrated to a maximum dose of 800 mg daily, or febuxostat, titrated to a maximum dose of 80 mg daily. The protocol specified that at least one-third of participants have stage 3 CKD. Thus, the trial design more closely reflects real-world clinical practice with regard to ULT titration, and the study population reflects the large number of people with gout and CKD.
The trial demonstrated that when allopurinol is dose escalated to achieve target serum urate, it is non-inferior to febuxostat. Both ULTs were effective, with 80% of participants achieving target urate, including in those with stage 3 CKD.
Abstract 0680: Gout stigma: Investigating the existence of gout stigma and its impact on patient perceptions and treatment decisions4
Research by Edwards NL, et al.
Gout has long been associated with negative stereotypes and the myth that it is self-inflicted. The management of gout is frequently suboptimal, and patients demonstrate poor adherence to urate-lowering therapies. Although the patient is frequently blamed for poor outcomes, healthcare providers and healthcare systems contribute to poor adherence and outcomes for many people with gout.
In this study of 27 practicing rheumatologists, the impact of clinicians’ perceptions about gout and patients’ personal behavior are highlighted. In addition, despite the efficacy of pegloticase in the management of gout, clinicians perceived biological therapy to be more effective in rheumatoid arthritis (RA) than gout.
As clinicians we need to be aware of our unconscious biases and how they may affect the management of our patients. We need further education of healthcare providers about gout and the role they and the healthcare system play in poor outcomes for people with gout.
Abstract 0675: Urate-lowering therapy for prevention of gout: Prespecified analyses from the CKD-FIX trial5
Research by Tiku A, et al.
The CKD-FIX trial randomized 369 adults with stage 3 or 4 CKD, no history of gout and the risk of CKD progression to receive allopurinol, up to 300 mg daily, or placebo. The mean serum urate concentration at randomization was 8.2 mg/dL (0.49 mmol/L) and the mean estimated glomerular filtration rate (eGFR) was 31.7 mL/min/1.73 m2. A prespecified analysis was undertaken to determine if allopurinol prevented incident gout in this at-risk population.
Interestingly, only 6.1% of participants experienced a gout flare over the 104-week study period, with no difference in incidence between those receiving allopurinol or placebo. However, those receiving allopurinol tended to have the first gout flare during the first 24 weeks of the study when allopurinol was being up-titrated, and those receiving placebo having their first flare after the first 24 weeks.