Intensive urate lowering of little benefit to patients with erosive gout

A more intensive serum urate-lowering therapy falls short of improving bone erosion scores in patients with erosive gout, in addition to being associated with a high treatment burden, as shown in a study.

The 2-year study included 104 patients with erosive gout who were receiving serum urate-lowering therapy orally and who had serum urate levels of ≥0.30 mmol/L at baseline. They were randomized to either an intensive serum urate target of <0.20 mmol/L or a standard target of <0.30 mmol/L (regarded as the standard as per rheumatology guidelines).

Researchers applied a standardized protocol (ie, maximum approved doses of allopurinol, probenecid, febuxostat, and benzbromarone) to titrate oral serum urate-lowering therapy to target.

Significantly fewer patients in the intensive target group than in the standard target group achieved the serum urate target level at year 2 (62 percent vs 83 percent; p<0.05), despite the intensive target group having significantly lower serum urate levels over the study period (p=0.002).

Compared with the standard target group, the intensive target group also required markedly higher doses of allopurinol (mean, 746 vs 497 mg/day; p<0.001) and received more combination therapy (p=0.0004).

There were small increases in the primary outcome of the total computed tomography bone erosion score over 2 years, with no significant difference between the two treatment groups (p=0.20). Likewise, both the intensive and standard target groups showed similar improvements in the secondary endpoints of the Outcome Measures in Rheumatology (OMERACT) core outcome domains (eg, gout flares, tophi, pain, patient's global assessment of disease activity, health-related quality of life, and activity limitation).

In terms of safety, the incidence of adverse event and serious adverse events was comparable between the groups.