Improvements in Health-Related Quality of Life with Treat-to-Target Urate-Lowering Therapy in Gout: A Post-hoc Analysis of a Randomized Multicenter Trial

Abstract

Background: While treat-to-target urate-lowering therapy (ULT) is endorsed as best practice in gout management, limited data exist on its impact on health-related quality of life (HRQoL). We assessed the impact of treat-to-target ULT on HRQoL among participants receiving protocolized gout care, identifying factors associated with HRQoL and HRQoL change.

Methods: This was a post-hoc analysis of a 72-week randomized trial, pooling data from allopurinol and febuxostat treatment arms. The VR-12 and EQ-5D-3L were administered at baseline, 24-, 48-, and 72-weeks. HRQoL changes over follow-up were examined using paired t-tests. Factors associated with baseline HRQoL were evaluated using multivariable linear regression. General estimating equations (GEE) were used to identify determinants of HRQoL change over follow-up.

Results: Participants (n=878) in this analysis were 98.9% male, had a mean age of 62.4 years, and 67.4% self-reported White race. HRQoL scores overall, and particularly the domains of physical function, mobility and pain, improved significantly over 72-weeks (p<0.001) with improvements noted by 24-weeks. Poorer enrollment HRQoL was associated with younger age, non-White race, tophi (for EQ-5D-3L), higher serum urate, and greater comorbidity. Baseline factors associated with HRQoL improvements over 72-weeks of ULT included lower C-reactive protein and lower comorbidity scores with similar changes observed by ULT assignment.

Conclusions: Treat-to-target ULT in gout is accompanied by HRQoL improvements evident by 24-weeks and sustained through 72-weeks. HRQoL gains with treat-to-target ULT are most prominent in the domains of physical function, mobility, and pain and are greatest in those with lower baseline levels of inflammation and comorbidity.