Op0116 Treat to Target in Gout Yields Superior Outcomes Compared to Treat to Avoid Symptoms Approach (Results From Gout Treatment Strategy (Go Test) Overture Trial)

Background: Both the European League Against Rheumatism (EULAR) and the American College for Rheumatology (ACR) state that gout can be effectively managed by reducing sUA levels below the physiological threshold of saturation using Urate Lowering Therapy (ULT), a Treat to Target approach(T2T). An alternative, more reactive management strategy, advocated by the American College of Physicians (ACP) is to treat symptoms and to base the start and dosing of ULT on avoiding (recurrent) symptoms, without monitoring sUA levels. This treat-to-avoid symptom (T2S) approach has been criticized by rheumatologists for potentially ignoring ongoing urate deposition until potentially severe disease manifestations become apparent. Although the solid underlying mechanism of gout is ignored, the lack of a head-to-head comparison of both strategies led the ACP to advise the T2S strategy for the treatment of gout. Objectives: The objective of the Gout TrEatment Strategy (GO TEST) OVERTURE trial is to compare a T2T strategy versus a T2S strategy for the management of gout. Methods: GO TEST OVERTURE study is a multicenter randomised controlled open-label pragmatic trial. Patients with a clinical diagnosis of gout, fulfilling the 2015 ACR-EULAR criteria, currently not using ULT but with an indication for the use of ULT were included. Patients with a contraindication for allopurinol, benzbromarone, and febuxostat including those with an eGFRResults: A total of 308 patients were eligible and included in the trial (T2T n=145; T2S n=163) with a mean sUA of 0.5 and 0.4 mMol/L and mean age of 62.5 at baseline in each group respectively. After 1-year, the proportion of patients achieving the target sUA level Conclusion: Our study is the first randomized trial to directly compare T2T with T2S as a control group in gout. We were able to show the superiority of the T2T management approach in gout. REFERENCES: NIL. Acknowledgements: The study sponsors ReumaNederland and ZonMw and we would like to thank the Principal Investigator(PI) Dr. Tim Th A Jansen (VieCuri Medical Center, The Netherlands), and the PIs of our participating centers: Dr. Lydia Schipper (Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands), Dr. Marcel Flendrie (Sint Maartenskliniek, Nijmegen, The Netherlands), Prof. Dr. Anna Elisa Boonen (Maastricht UMC+, Maastricht, The Netherlands) Dr. Reinhard Bos (Medical Center Leeuwarden, Leeuwarden, The Netherlands), Dr. Martijn Gerritsen (Reade, Amsterdam, The Netherlands), Dr. Robbie Geilen (Elkerliek hospital, Helmond, The Netherlands) and their colleagues for helping us successfully implement the (on-going) GO TEST Overture study. Disclosure of Interests: Anusha Moses: None declared, Martijn Oude Voshaar: None declared, Tim Jansen: None declared, Mart van de Laar Eli Lily (study grant), Eli Lily.