Comparative Study of Real-Life Management Strategies in Gout: Data From Two Protocolized Gout Clinics.
Aged
Allopurinol
/ therapeutic use
Clinical Decision Rules
Clinical Protocols
Female
Follow-Up Studies
Gout
/ blood
Gout Suppressants
/ therapeutic use
Humans
Logistic Models
Male
Middle Aged
Patient Satisfaction
Precision Medicine
/ methods
Symptom Flare Up
Treatment Outcome
Uric Acid
/ blood
Uricosuric Agents
/ therapeutic use
Journal
Arthritis care & research
ISSN: 2151-4658
Titre abrégé: Arthritis Care Res (Hoboken)
Pays: United States
ID NLM: 101518086
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
29
10
2018
accepted:
28
05
2019
pubmed:
1
6
2019
medline:
7
10
2020
entrez:
1
6
2019
Statut:
ppublish
Résumé
To compare outcomes of 2 gout clinics that implemented different treatment strategies. Patients newly diagnosed with gout and a follow-up of 9-15 months were included. Co-primary outcomes were the proportion of patients reaching a serum uric acid (UA) ≤0.36 mmoles/liter and free of flares. Secondary outcomes were the proportion of patients requiring treatment intensification and experiencing adverse events. One clinic adopted a strict serum UA (≤0.30 mmoles/liter target) strategy, with early addition of a uricosuric to allopurinol, and the other clinic adopted a patient-centered (PC) strategy emphasizing a shared decision based on serum UA and patient satisfaction with gout control. Independent t-tests or chi-square tests were used to test differences in outcomes, and logistic regressions were used to adjust the effect of the treatment center on outcomes for confounders. In total, 126 and 86 patients had a follow-up mean ± SD of 11.3 ± 1.8 versus 11.1 ± 1.9 months. In the UA strategy, 105 of 126 patients (83%) compared to 63 of 86 (74%) in the PC strategy (P = 0.10) reached the threshold of ≤0.36 mmoles/liter; and 58 of 126 (46%) versus 31 of 86 (36%) were free of flares (P = 0.15). In the UA strategy, 76 of 126 patients (60%) were on allopurinol monotherapy compared to 63 of 86 (73%) in the PC strategy (P = 0.05), yet the number of adverse events was not different (n = 25 [20%] versus n = 20 [23%]; P = 0.55). Adjusting for confounders did not substantially change these associations. A strict UA strategy resulted in a nonsignificantly higher proportion of patients reaching a serum UA ≤0.36 mmoles/liter and being free of flares. This result was accomplished with significantly more therapy intensification. The small sample size plays a role in the significance of results.
Substances chimiques
Gout Suppressants
0
Uricosuric Agents
0
Uric Acid
268B43MJ25
Allopurinol
63CZ7GJN5I
Types de publication
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1169-1176Informations de copyright
© 2019, American College of Rheumatology.
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