Treatment sequence patterns of urate-lowering therapy in Korean patients with gout: A common data model-based study

Clinical Snapshot

Key Findings

• P Value: P = 0.33 for febuxostat modification strategies; P < 0.001 for allopurinol modification preferences

• Effect Size: Febuxostat first-line retention: 90.9%; switching vs add-on similar retention (91.5% vs 86.8%)

• Primary Outcome: Treatment retention rates across different ULT sequences

• Nnt Or Sensitivity: Febuxostat was most common first-line agent (51.4% of patients)

• Confidence Interval: Not reported

Clinical Application

Findings support flexible treatment sequencing approaches in clinical practice Limited applicability due to different PBS restrictions and prescribing patterns; febuxostat access more restricted in Australia compared to Korea Adult patients with gout requiring urate-lowering therapy, particularly those considering treatment modification

Abstract

BACKGROUND: A treat-to-target strategy involving treatment modification improves outcomes in gout, but evidence remains limited regarding the optimal approach when initial urate-lowering therapy (ULT) fails. This study aimed to investigate real-world ULT sequence patterns and evaluate treatment retention based on the initial agent, modification type, and comorbidities. METHOD: We analyzed electronic health record data collected from 2010 to 2022 from the common data model databases of two hospitals. Adults aged 18 years or older diagnosed with gout who initiated ULT and were followed for at least 2 years were included. Outcomes included the frequency and sequence of ULT prescriptions. Treatment modification, defined as switching to another ULT or adding an additional agent, was considered the end of retention for the previous regimen. Subgroup analyses were performed based on comorbidity. RESULTS: Among 2220 patients, febuxostat was the most common first-line agent (51.4%), with 90.9% maintaining therapy. Among those who modified febuxostat therapy, switchers and add-on users continued treatment similarly (91.5% vs. 86.8%, P = 0.33). Of allopurinol initiators, 55.8% changed therapy, mainly switching to febuxostat or benzbromarone rather than adding another agent (51.4% vs. 4.1%, P < 0.001), with similar retention rates (91.5% vs. 86.8%, P = 0.33). Among benzbromarone initiators, 57.2% changed therapy (switchers, 56.7%; add-on users, 0.5%; P < 0.001), and retention rates were 90.5% and 100%, respectively (P = 1.00). Chronic kidney disease was associated with low variability in ULT sequence. CONCLUSIONS: ULT demonstrated durable retention when used as first- or second-line treatment, with switching being more common than add-on therapy and maintaining similar retention rates.

References

1. 1.Kim, M. J., Park, E. G., Kim, C., Kang, D. Y., Ryu, B., & Shin, K. (2026). Treatment sequence patterns of urate-lowering therapy in Korean patients with gout: A common data model-based study. PLoS One. https://doi.org/10.1371/journal.pone.0347654