SAT0421\u2005LONG-TERM URATE-LOWERING THERAPY: IS IT ‘ALL LIFELONG’ NECESSARY?

Abstract

Background: It has been published that 13% of gout patients remain in a situation of normouricemia after the suspension of urate-lowering therapy (ULT) and, consequently, would not require lifelong treatment. Prospective and specialized follow-up in a tertiary care centre may have favored these positive outcomes, which have not been replicated afterwards. Objectives: To assess the percentage of patients diagnosed with gout, previously followed in Rheumatology consultations, in situation of normouricemia once ULT is suspended. Methods: A transverse study of patients with gout included in an inception cohort and followed in a tertiary care centre. Selected patients were no longer followed by specialized attention. Data, including active prescription of ULT, time since suspension of ULT (if applicable), last serum uric acid (sUA) levels and time for that determination, were procured by electronic history. General data of patients and follow-up were obtained from the database of such cohort. Results: One hundred and forty-two (27.4%) out of 518 patients, with available data accessed by electronic history, lacked prescription of ULT, with an average time since its interruption of 65 months (58, 28-120) and sUA average levels of 7.2±1.7 mg/dl. Nevertheless, 19.2% of these patients showed sUA levels <6 mg/dl, against 61% and 63% of patients with active ULT prescription followed by primary care and specialized care, respectively. Considering a higher target level of uric acid in the long run and taking into account that these patients had already received treatment for an average mean of 50 months, either in patients with active ULT prescription or patients without it (p=0.35), 41.7% of patients without ULT showed sUA levels <6.8 mg/dl vs. 77% of those with an active ULT prescription (both primary and specialized care). Patients without ULT, showing sUA levels <6 mg/dl or <6.8 mg/dl also showed lower sUA levels during previous follow-up in Rheumatology consultations than those with sUA levels out of target (4.9mg/dl vs. 5.2mg/dl, p<0.01 and 5.0mg/dl vs. 5.3mg/dl). Likewise, among patients with sUA levels <6mg/dl during follow-up, 25.3% showed sUA levels <6mg/dl vs. 0% of those with sUA levels >6mg/dl during follow-up (p<0.01). Conclusion: Between 20% and 40% of patients without a prescription of ULT, previously followed by Rheumatology, showed sUA levels <6mg/dl and <6.8mg/dl, respectively. Patients with sUA levels below target during follow-up show a higher rate of sUA levels in target once ULT is suspended. References [1] Perez Ruiz F, Sanchez-Piedra CA, Sanchez-Costa JT, et al. Improvement in Diagnosis and Treat-to-Target Management of Hyperuricemia in Gout: Results from the GEMA-2 Transversal Study on Practice. Rheumatol Ther. 2017;5(1):243-253. [2] Richette P, Doherty M, Pascual E, et al. 2016updated EULAR evidence-based recommendations for the management of gout. Annals of the Rheumatic Diseases2017;76:29-42. [3] Yin R, Li L, Zhang G, et al. Rate of adherence to urate-lowering therapy among patients with gout: a systematic review and meta-analysis. BMJ Open. 2018;8(4):e017542. Published 2018 Apr 10. doi:10.1136/bmjopen-2017-017542 Disclosure of Interests: Paula García: None declared, Boris Anthony Blanco Cáceres: None declared, Fernando Perez-Ruiz Grant/research support from: Asociación reumatólogos de Cruces, Consultant for: Grünenthal Horizon Menarini, Speakers bureau: Grünenthal, Menarini, Fundación Española Reumatologiá