Real-world persistence of urate-lowering therapy following a treat-to-target intervention: A two-year follow-up analysis of the STOP gout trial.

IF 4.4 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism Pub Date : 2025-10-01 Epub Date: 2025-08-05 DOI:10.1016/j.semarthrit.2025.152800

Samantha Kohn, Harlan Sayles, Lindsay N Helget, Bryant R England, Punyasha Roul, Jeff A Newcomb, Bridget Kramer, Anne Davis-Karim, Mary T Brophy, Ryan Ferguson, Michael H Pillinger, Tuhina Neogi, Paul M Palevsky, Hongsheng Wu, James R O'Dell, Ted R Mikuls

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引用次数: 0

Abstract

Objective: Though gout guidelines endorse treat-to-target urate-lowering therapy (ULT), its long-term durability following treat-to-target implementation has not been extensively studied. Examining follow-up data from a trial implementing treat-to-target management, we evaluated the frequency and determinants of ULT persistence.

Methods: This analysis examined participants completing the 72-week STOP Gout trial with available follow-up data extending 2-years post-study. Participants were followed passively using administrative and electronic health record data with persistence defined by a ULT dispensing episode overlapping with the 2-year post-study time point. Associations of participant factors with ULT persistence were examined using multivariable logistic regression.

Results: Participants in this analysis (n = 638) were predominantly male (99 %) and had a mean age of 62.7 years. At 2-years post-study, 66 % continued ULT. Adjusting for covariates, ≥2 rheumatology visits post-study (vs. none) was associated with greater ULT persistence (aOR 1.75; 95 % CI 1.13-2.72). ULT persistence was lower in individuals reporting 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. Though not reaching significance, achievement of serum urate goal at 48-weeks during STOP Gout study demonstrated a borderline association with greater long-term persistence (aOR 1.68; 95 % CI 0.99-2.85).

Conclusion: 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.

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在治疗到目标干预后，现实世界中降低尿酸治疗的持久性：对停止痛风试验的两年随访分析。

目的：虽然痛风指南支持治疗-目标尿酸降低疗法（ULT），但其在治疗-目标实施后的长期持久性尚未得到广泛研究。通过检查一项实施治疗到目标管理的试验的随访数据，我们评估了ULT持续存在的频率和决定因素。方法：本分析检查了完成72周停止痛风试验的参与者，并提供了研究后2年的随访数据。使用管理和电子健康记录数据对参与者进行被动跟踪，持续时间定义为与研究后2年时间点重叠的ULT分配事件。使用多变量逻辑回归检查参与者因素与ULT持久性的关联。结果：本分析的参与者（n = 638）主要为男性（99%），平均年龄为62.7岁。在研究后2年，66%的患者继续接受ULT治疗。调整协变量后，研究后≥2次风湿病就诊（vs.无）与更大的ULT持久性相关(aOR 1.75；95% ci 1.13-2.72)。报告黑人/非裔美国人种族的个体的ULT持久性较低(aOR 0.56；95% CI 0.36-0.87)，西班牙裔(aOR 0.21；95% CI 0.09-0.50)，在研究后随访开始时生活质量更好。虽然没有达到显著性，但在停止痛风研究中，在48周时达到血清尿酸目标表明与更大的长期持续性存在边缘关联(aOR 1.68；95% ci 0.99-2.85)。结论：尽管实施从治疗到目标的ULT的干预措施在试验中证明了有效性，但本研究表明，在过渡到现实世界的痛风管理后，这种干预措施的持久性可能有限。在代表性不足的患者群体中，有限的治疗持久性问题似乎变得更加复杂，并在持续的风湿病护理背景下得到改善。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Seminars in arthritis and rheumatism 医学-风湿病学

CiteScore

9.20

自引率

4.00%

发文量

176

审稿时长

46 days

期刊介绍： Seminars in Arthritis and Rheumatism provides access to the highest-quality clinical, therapeutic and translational research about arthritis, rheumatology and musculoskeletal disorders that affect the joints and connective tissue. Each bimonthly issue includes articles giving you the latest diagnostic criteria, consensus statements, systematic reviews and meta-analyses as well as clinical and translational research studies. Read this journal for the latest groundbreaking research and to gain insights from scientists and clinicians on the management and treatment of musculoskeletal and autoimmune rheumatologic diseases. The journal is of interest to rheumatologists, orthopedic surgeons, internal medicine physicians, immunologists and specialists in bone and mineral metabolism.