Time Trends and Predictors of Gout Remission Over Six Years

Abstract

OBJECTIVES: This study aims to describe the trends in remission rates over six years of follow-up among people with gout taking urate-lowering therapy (ULT), and to identify variables that predict remission. METHODS: A post hoc analysis was conducted using data from the Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout (CARES) trial, which enrolled people with gout and cardiovascular disease randomised to febuxostat or allopurinol. Gout remission over six years of follow-up was measured in participants with at least one year of follow-up data using the simplified gout remission definition, requiring the fulfilment of three domains, a) no gout flares during the past year, b) at least two serum urate measurements <0.36mmol/l during the past year, and c) no tophus. Logistic regression was used to identify baseline predictors of remission. RESULTS: Achievement of remission increased from 37.4% of participants (1593/4259) at year 1 to 63.1% (322/510) at year 6. Across the six years, 59.4% of participants achieved remission at least once. More participants on febuxostat achieved remission during the first two years, primarily due to a higher number achieving the serum urate remission domain. In multivariable analysis, baseline age, race, greater disease severity, presence of comorbidities, and febuxostat treatment were variables significantly associated with remission. CONCLUSION: On ULT, fulfilment of remission increases over time and remission can be achieved in the majority of patients. Baseline predictors, including demographics, comorbidities and disease severity, may be useful to identify people with gout who need more proactive management to achieve remission.