Ab0122 Treatment Sequence Patterns of Urate-Lowering Therapy for Gout Based on a Common Data Model

Background: Treat-to-target strategy for gout has led to better outcomes and quality of life in patients. However, it encloses limited information on the optimal treatment strategy following the treatment failure of an initial urate-lowering agent (ULA). Objectives: To investigate the treatment sequence patterns of ULAs in the patient with gout. Methods: This study utilized electronic health record-based data from two centers distally located in Korea (BMC, UUH). Both databases were standardized based on a Common Data Model. Participants included patients 18 years or older with a diagnosis of gout and those who had at least 2 years of follow-up data between 2010 to 2022. Outcomes were the prescription frequency of different ULAs (allopurinol, febuxostat, and benzbromarone), as well as the sequence of the agents received in the line of therapy. A switch to, or addition of, a new ULA was considered a new line of therapy. Subgroup analyses were performed centered on baseline serum urate levels and comorbidities. Results: A total of 2743 eligible patients were identified in the two databases (1317 patients from BMC and 1426 patients from UUH). At BMC, febuxostat was the most prescribed medication, representing 55.2% of the initial treatment; 87.7% of patients continued the agent. For second-line therapy to febuxostat, more patients switched to allopurinol (63.1%) than either adding or switching to benzbromarone (36.9%). Meanwhile, half of the patients who initiated allopurinol switched to febuxostat, and 96.6% of these patients continued using febuxostat. At UUH, allopurinol was the dominant first-line agent (49.5%); 98% of switchers from allopurinol to febuxostat continued the agent, while 69% of those who either added or switched to benzbromarone from allopurinol changed to febuxostat in the subsequent lines of therapy. In both databases, patients with a high baseline serum urate level (≥9 mg/dL) tended to switch from allopurinol to febuxostat than the overall population (60% vs. 50% at BMC; 62% vs. 54% at UUH). There were allopurinol users with end-stage renal disease that switched to febuxostat (20.7% at BMC; 38.9% at UUH), but not vice versa. Conclusion: Our study shows the difference in first-line ULA between centers, yet febuxostat eventually was the predominantly used ULA in real-world practice. Furthermore, the sequence of urate-lowering therapy varied depending on the initial agent, baseline serum urate level, or renal function. REFERENCES: [1] Fernando Perez-Ruiz, Aitana Moreno-Lledó, Irati Urionagüena, Alastair J. Dickson, Treat to target in gout, Rheumatology, Volume 57, Issue suppl_1, January 2018, Pages i20–i26. Acknowledgements: NIL. Disclosure of Interests: None declared.