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

Objective: Although 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 Veterans RAND-12 Item Health Survey and EuroQol 5-Dimension 3-Level (EQ-5D-3L) were administered at baseline and at 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 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 level, and greater comorbidity. Baseline factors associated with HRQoL improvements over 72 weeks of ULT included lower C-reactive protein level and lower comorbidity scores with similar changes observed by ULT assignment.

Conclusion: 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.