Evaluation of Real-World Treatment Patterns and Healthcare Resource Utilization in Patients with Chronic Refractory Gout in the United States.

Introduction: Chronic refractory gout (CRG) is characterized by frequent flares and failure to achieve and/or maintain serum urate levels < 6.0 mg/dL with conventional urate-lowering therapies. This study evaluated the clinical profile, treatment patterns, and healthcare resource utilization (HRU) of patients with CRG in the United States (US) to provide updated information on treatment strategies and burdens.

Methods: This retrospective cohort study analyzed data for patients with CRG (≥ 3 flares within 18 months or a pegloticase prescription following gout diagnosis) between June 2011 and May 2020 in the IQVIA PharMetrics^® Plus database linked with IQVIA Ambulatory Electronic Medical Records-US. Demographic, clinical, and disease characteristics, gout-related medications, and HRU were described for patients with serum urate levels ≥ 6.0 mg/dL at baseline and in the subset with elevated levels (≥ 2 measurements ≥ 6.0 mg/dL) during the 12-month follow-up period.

Results: Among 969 patients with CRG, 157 had elevated serum urate levels ≥ 6.0 mg/dL during follow-up. All patients had a high comorbidity burden. Most patients in the overall population (57.5%) and in the subset with elevated serum urate during follow-up (73.2%) did not have evidence of achieving serum urate level < 6.0 mg/dL at any point during follow-up, despite use of gout-related medications including allopurinol. Patients in the overall population and the elevated serum urate subset had high use of steroids (77.0% and 79.6%, respectively) and nonsteroid anti-inflammatory drugs (59.3% and 59.9%) to manage gout flares. Additionally, patients had high rates of gout-related HRU, including inpatient admissions [5.7% (overall) and 6.4% (subset)], emergency room visits (12.7% and 15.3%), and outpatient visits (96.8% and 100%).

Conclusion: Despite the use of urate-lowering medications, patients with CRG had elevated serum urate levels and high HRU, underscoring the need for better treatment and management strategies for CRG to prevent gout flares and minimize long-term damage.