Soloman N1, Amin M2, Helfgott SM3, Hu A2, Huston K4, Leonard J2, Milligan K5, Milligan S6, Singh JA7, Tesser J1, Edgerton C8
1Arizona Arthritis, Phoenix, AZ, USA, 2Arizona Arthritis & Rheumatology Associates, Phoenix, AZ, USA, 3Brigham and Women's Hospital, Boston, MA, USA, 4The Center for Rheumatic Disease & Allergy-Immunology, Kansas City, MO, USA, 5Trio Health Advisory, La Jolla, CA, USA, 6Trio Health Analytics, Louisville, CO, USA, 7University of Alabama at Birmingham, Birmingham, AL, USA, 8Articularis Healthcare, Summerville, SC, USA
OBJECTIVES : To examine treatment for gout following pegloticase discontinuation for patients in US clinical care. METHODS : Study population: 70 gout-diagnosed patients who initiated their last pegloticase course between Jan 2015 and Dec 2019 with >90 days follow-up from pegloticase discontinuation (index). Statistical analyses included t-test (continuous variables), chi-square or Fischer’s exact tests (categorical variables), and Kaplan-Meier and log-rank test (time to event). Assessments of serum uric acid (sUA) were limited to patients with 2+ measures. RESULTS : At ≥90 days past pegloticase discontinuation, 49/70 (70%) initiated a uric acid lowering therapy (ULT). Median time from index to ULT was 13 days; 76% (37/49) occurred within 30 days, 90% (44/49) 90 days, and 96% (47/49) 180 days. Median follow up for patients who did not initiate a subsequent ULT was 404 days, greater than but not significantly different from patients that did initiate ULT post-pegloticase (322 days, p=0.270). The absence of kidney disease was significantly associated with ULT initiation within 180 days (39/47, 83% v. 14/23, 61% non-initiators, p=0.043); variables NOT associated included age, gender, race, ethnicity, payer, CVD, diabetes, non-gout rheumatic diseases, duration of prior pegloticase, and sUA ≥6 mg/dL during pegloticase or at pegloticase discontinuation. Of the 47 patients that initiated subsequent ULT within 180 days, 22 of 47 had 2+ sUA measures during treatment, and 9/22 (41%) had 2+ sUA ≥6 mg/dL. Two or more sUA results post-pegloticase were provided for 6/23 patients that did not initiate ULT within 180 days; 5/6 (83%) had 2+ sUA ≥6 mg/dL. CONCLUSIONS : Consistent sUA <6 ml/dL was not maintained post-pegloticase for half (14/28) of the evaluable patients. As the 2020 ACR Guidelines advises the treat to target approach to maintain sUA <6 ml/dL, our results highlight the need for new ULTs and/or better strategies to maximize benefit with available therapies.
Conference/Value in Health Info
2021-05, ISPOR 2021, Montreal, Canada
Value in Health, Volume 24, Issue 5, S1 (May 2021)
Clinical Outcomes, Health Service Delivery & Process of Care
Clinical Outcomes Assessment, Disease Management