Reassurance on CV risk with treat-to-target strategies in gout
medwireNews: Findings from an observational study designed to emulate a clinical trial suggest that treat-to-target (TTT) serum urate-lowering strategies for gout are not associated with higher cardiovascular (CV) risk than less intensive approaches.
The study included data for 4402 individuals aged 65 years and older from the US Medicare database who initiated treatment with allopurinol (96%) or febuxostat (4%) in 2007–2016. A “clone-censor-weight” statistical approach was used to compare the estimated risk for major adverse cardiovascular events (MACE) across seven different treatment strategies for urate-lowering therapy (ULT) during 11,515 person–years of follow-up. These strategies ranged from ULT initiation only to more intensive TTT strategies involving regular serum urate monitoring and ULT dose titration.
The researchers found that two of the TTT strategies – namely initiation and continuation of ULT with serum urate monitoring every 6 months and the same strategy with additional titration of ULT based on serum urate levels – were associated with significantly lower MACE risk when compared with ULT initiation alone (with no requirements for continuation or monitoring), at adjusted rate ratios of 0.81 and 0.86, respectively.
However, when initiation and continuation of ULT (without monitoring) was used as the comparator, MACE risk did not significantly differ between the different TTT strategies, reported Kazuki Yoshida (Brigham and Women's Hospital, Boston, Massachusetts, USA) in a poster presentation at the ACR Convergence 2021 virtual meeting.
Despite the CV safety concerns with ULT, these findings suggest similar event rates with TTT versus less intensive strategies, but “future randomized clinical trials are required to confirm our results,” concluded Yoshida.
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