Minority of patients with gout receive treat-to-target care worldwide, varies by country
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Although there are few studies on the subject outside of North America and Europe, the available data suggest that a minority of patients with gout receive treat-to-target care worldwide, according to data.
“Almost all international gout management guidelines, including from the American College of Rheumatology, European League Against Rheumatism, and the Chinese Multidisciplinary Expert Task Force on Hyperuricemia and Related Diseases, advocate a treat-to serum urate target (T2T) approach in patients who have indications for [urate lowering therapy (ULT)],” Chang-Nam Son, MD, PhD, of the University of Auckland, in New Zealand, and colleagues wrote in Seminars in Arthritis and Rheumatism. “This approach is supported by patients with gout.”
“The core elements of the T2T approach in gout are regular ULT prescription, serum urate testing, and ULT dose titration to a specific urate target (usually below 6mg/dL or 0.36mmol/L, with lower targets recommended for patients with tophi),” they added. “A number of studies have reported on the quality of care received by patients with gout at a regional or national level. However, the global patterns in T2T care have not been synthesized.”
To examine global treat-to-target care among patients with gout, Son and colleagues conducted a systematic review and meta-analysis of studies reporting medication and serum urate testing. Their review, conducted in April 2020 with an updated search in April 2021, included the PubMed, Ovid Medline, Embase and Cochrane Library.
Specific treat-to-target indicators included in the analysis were: The proportion of patients receiving any ULT, the proportion receiving regular uninterrupted ULT, the proportion of ULT users receiving regular uninterrupted ULT, the proportion of ULT users with any serum urate testing, the proportion of ULT users with serum urate testing after initiating or altering ULT, and the proportion of ULT users who achieve a serum urate target of below 6mg/dL or 0.36mmol/L.
In all, the Son and colleagues identified and included 67 studies in their analysis. Among these, 31 were from North America, 22 were from Europe, seven originated in Oceania, six were conducted in Asia and one reported data from multiple continents. The researchers then calculated global pooled percentages for patients with gout who achieved each treat-to-target indicator.
According to the researchers, the global pooled data indicate that 52% (95% CI, 45% to 59%) of patients with gout around the world are on ULT. Among those on ULT, 50% (95% CI, 40% to 61%) are receiving regular uninterrupted ULT, and 53% (95% CI, 40% to 65%) have undergone any serum urate testing. Meanwhile, 44% of patients starting or changing ULT had serum urate testing, and 34% (95% CI, 28% to 41%) of those on ULT are achieving a serum urate target.
“Serum urate testing is an essential component of the T2T approach in gout management. Just over half of ULT users received any urate testing, and 44% of patients starting or changing ULT had serum urate testing,” Son and colleagues wrote. “The percentage of serum urate testing in patients taking ULT was higher in Aotearoa/New Zealand, the USA and Australia compared to European countries. This may be due to serum urate often being assayed as part of routine biochemistry analyses in some regions of Australia, which may not be the case in other countries.”
“Outside North America and Europe, there are relatively few studies about T2T care for gout management,” they added. “However, available data demonstrate that a minority of people with gout receive T2T care worldwide. For those prescribed ULT, there are low rates of continuous therapy, serum urate testing, and achievement of serum urate target.”
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