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Treat-to-target urate-lowering therapy and hospitalizations for gout: results from a nationwide cohort study in England

OBJECTIVE: To investigate associations between treat-to-target urate-lowering therapy (ULT) and hospitalizations for gout. METHODS: Using linked Clinical Practice Research Datalink and NHS Digital Hospital Episode Statistics data, we described the incidence and timing of hospitalizations for flares...

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Autores principales: Russell, Mark D, Roddy, Edward, Rutherford, Andrew I, Ellis, Benjamin, Norton, Sam, Douiri, Abdel, Gulliford, Martin C, Cope, Andrew P, Galloway, James B
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10321109/
https://www.ncbi.nlm.nih.gov/pubmed/36355461
http://dx.doi.org/10.1093/rheumatology/keac638
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author Russell, Mark D
Roddy, Edward
Rutherford, Andrew I
Ellis, Benjamin
Norton, Sam
Douiri, Abdel
Gulliford, Martin C
Cope, Andrew P
Galloway, James B
author_facet Russell, Mark D
Roddy, Edward
Rutherford, Andrew I
Ellis, Benjamin
Norton, Sam
Douiri, Abdel
Gulliford, Martin C
Cope, Andrew P
Galloway, James B
author_sort Russell, Mark D
collection PubMed
description OBJECTIVE: To investigate associations between treat-to-target urate-lowering therapy (ULT) and hospitalizations for gout. METHODS: Using linked Clinical Practice Research Datalink and NHS Digital Hospital Episode Statistics data, we described the incidence and timing of hospitalizations for flares in people with index gout diagnoses in England from 2004–2020. Using Cox proportional hazards and propensity models, we investigated associations between ULT initiation, serum urate target attainment, colchicine prophylaxis, and the risk of hospitalizations for gout. RESULTS: Of 292 270 people with incident gout, 7719 (2.64%) had one or more hospitalizations for gout, with an incidence rate of 4.64 hospitalizations per 1000 person-years (95% CI 4.54, 4.73). There was an associated increased risk of hospitalizations within the first 6 months after ULT initiation, when compared with people who did not initiate ULT [adjusted Hazard Ratio (aHR) 4.54; 95% CI 3.70, 5.58; P < 0.001]. Hospitalizations did not differ significantly between people prescribed vs not prescribed colchicine prophylaxis in fully adjusted models. From 12 months after initiation, ULT associated with a reduced risk of hospitalizations (aHR 0.77; 95% CI 0.71, 0.83; P < 0.001). In ULT initiators, attainment of a serum urate <360 micromol/l within 12 months of initiation associated with a reduced risk of hospitalizations (aHR 0.57; 95% CI 0.49, 0.67; P < 0.001) when compared with people initiating ULT but not attaining this target. CONCLUSION: ULT associates with an increased risk of hospitalizations within the first 6 months of initiation but reduces hospitalizations in the long term, particularly when serum urate targets are achieved.
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spelling pubmed-103211092023-07-06 Treat-to-target urate-lowering therapy and hospitalizations for gout: results from a nationwide cohort study in England Russell, Mark D Roddy, Edward Rutherford, Andrew I Ellis, Benjamin Norton, Sam Douiri, Abdel Gulliford, Martin C Cope, Andrew P Galloway, James B Rheumatology (Oxford) Clinical Science OBJECTIVE: To investigate associations between treat-to-target urate-lowering therapy (ULT) and hospitalizations for gout. METHODS: Using linked Clinical Practice Research Datalink and NHS Digital Hospital Episode Statistics data, we described the incidence and timing of hospitalizations for flares in people with index gout diagnoses in England from 2004–2020. Using Cox proportional hazards and propensity models, we investigated associations between ULT initiation, serum urate target attainment, colchicine prophylaxis, and the risk of hospitalizations for gout. RESULTS: Of 292 270 people with incident gout, 7719 (2.64%) had one or more hospitalizations for gout, with an incidence rate of 4.64 hospitalizations per 1000 person-years (95% CI 4.54, 4.73). There was an associated increased risk of hospitalizations within the first 6 months after ULT initiation, when compared with people who did not initiate ULT [adjusted Hazard Ratio (aHR) 4.54; 95% CI 3.70, 5.58; P < 0.001]. Hospitalizations did not differ significantly between people prescribed vs not prescribed colchicine prophylaxis in fully adjusted models. From 12 months after initiation, ULT associated with a reduced risk of hospitalizations (aHR 0.77; 95% CI 0.71, 0.83; P < 0.001). In ULT initiators, attainment of a serum urate <360 micromol/l within 12 months of initiation associated with a reduced risk of hospitalizations (aHR 0.57; 95% CI 0.49, 0.67; P < 0.001) when compared with people initiating ULT but not attaining this target. CONCLUSION: ULT associates with an increased risk of hospitalizations within the first 6 months of initiation but reduces hospitalizations in the long term, particularly when serum urate targets are achieved. Oxford University Press 2022-11-10 /pmc/articles/PMC10321109/ /pubmed/36355461 http://dx.doi.org/10.1093/rheumatology/keac638 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Science
Russell, Mark D
Roddy, Edward
Rutherford, Andrew I
Ellis, Benjamin
Norton, Sam
Douiri, Abdel
Gulliford, Martin C
Cope, Andrew P
Galloway, James B
Treat-to-target urate-lowering therapy and hospitalizations for gout: results from a nationwide cohort study in England
title Treat-to-target urate-lowering therapy and hospitalizations for gout: results from a nationwide cohort study in England
title_full Treat-to-target urate-lowering therapy and hospitalizations for gout: results from a nationwide cohort study in England
title_fullStr Treat-to-target urate-lowering therapy and hospitalizations for gout: results from a nationwide cohort study in England
title_full_unstemmed Treat-to-target urate-lowering therapy and hospitalizations for gout: results from a nationwide cohort study in England
title_short Treat-to-target urate-lowering therapy and hospitalizations for gout: results from a nationwide cohort study in England
title_sort treat-to-target urate-lowering therapy and hospitalizations for gout: results from a nationwide cohort study in england
topic Clinical Science
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10321109/
https://www.ncbi.nlm.nih.gov/pubmed/36355461
http://dx.doi.org/10.1093/rheumatology/keac638
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