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Background/Purpose Little is known about long-term clinical outcomes or urate-lowering (ULT) therapy use following pegloticase discontinuation. We examined ULT use, serum urate (SU), inflammatory biomarkers, and renal function following pegloticase discontinuation. Methods We conducted a retrospective analysis of gout patients who discontinued pegloticase using the Rheumatology Informatics System for Effectiveness (RISE) registry from 1/2016 to 6/2022. We defined discontinuation as a gap ≥ 12 weeks after last infusion. We examined outcomes beginning two weeks after last dose and identified ULT therapy following pegloticase discontinuation. We evaluated changes in lab values (SU, eGFR, CRP and ESR), comparing on- treatment (≤ 15 days of the second pegloticase dose) to post-treatment. Results Of the 375 gout patients discontinuing pegloticase, median (IQR) laboratory changes following discontinuation were: SU: +2.4 mg/dL (0.0,6.3); eGFR: -1.9 mL/min (− 8.7,3.7); CRP: -0.8 mg/L (-12.8,0.0); and ESR: -4.0 mm/hr (-13.0,0.0). Therapy post-discontinuation included oral ULTs (86.0%), restarting pegloticase (4.5%), and no documentation of ULT (9.5%), excluding patients with multiple same-day prescriptions ( n  = 17). Oral ULTs following pegloticase were: 62.7% allopurinol, 34.1% febuxostat. The median (IQR) time to starting/restarting ULT was 92.0 days (55.0,173.0). Following ULT prescribing (≥ 30 days), only 51.0% of patients had SU < 6 mg/dL. Patients restarting pegloticase achieved a median SU of 0.9 mg/dL (IQR:0.2,9.7) and 58.3% had an SU < 6 mg/dL. Conclusion Pegloticase treats uncontrolled gout in patients with failed response to xanthine oxidase inhibitors, but among patients who discontinue, optimal treatment is unclear. Based on this analysis, only half of those starting another ULT achieved target SU. Close follow-up is needed to optimize outcomes after pegloticase discontinuation. Rheumatology key messages Information about gout treatment following pegloticase discontinuation is limited. We found that after discontinuing pegloticase, patients frequently used oral ULTs (86% of those discontinuing pegloticase). Approximately 77% started ULTs or restarted pegloticase within 6 months of pegloticase discontinuation. This gap in switching to another ULT suggests greater need for more optimal management of gout patients who discontinue pegloticase or have meaningful gaps in treatment. Approximately 58% of patients who restarted pegloticase had a SU < 6 mg/dL as measured at a median (IQR) interval of 45.5 (39.8, 53.0) days. The context for pegloticase interruptions needs to be further explored.

Objective Glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) such as semaglutide (SEM) and tirzepatide (TZP) were initially approved for type 2 diabetes management but are increasingly used for weight loss. Limited data exist on real‐world use among patients with rheumatic and musculoskeletal diseases (RMDs). This study aimed to describe characteristics and trends in SEM and TZP initiation among individuals with RMDs and to identify factors associated with weight loss. Methods We conducted a retrospective analysis using the American College of Rheumatology's Rheumatology Informatics System for Effectiveness registry. Adults with RMD prescribed SEM or TZP between 2018 and 2024 were included. Patients with an evaluation and management visit before first GLP‐1 RA prescription were classified as new users. The primary outcome was percent change in body weight from baseline to 12 months. Multivariable linear regression assessed factors associated with percent weight change, and logistic models identified predictors of ≥5%, ≥10%, and ≥15% weight loss. Results Among 60,198 patients with RMD treated with GLP‐1 RAs (72% SEM), 80.5% were female, and 54.9% had diabetes; the mean age was 57.0 years, and body mass index was 36.4. GLP‐1 RA use increased from 0.1% in 2018 to 6.8% in 2024. At 12 months, SEM and TZP users lost 5.8% and 8.2% of body weight, respectively. TZP users lost 2.2% (95% confidence interval [CI] 1.9–2.5) more weight than SEM users, and those without diabetes lost 1.8% (95% CI 1.5–2.1) more than those with diabetes. Conclusion GLP‐1 RA use is increasing among patients with RMD and is associated with clinically meaningful weight loss, particularly with TZP and in individuals without diabetes.

ObjectiveStudies of dermatomyositis (DM) are frequently limited to single-centre cohorts. We used two large nationally representative US cohorts to conduct a descriptive epidemiological study of the characteristics, treatments and outcomes of patients with incident DM.MethodsThis retrospective study identified two DM inception cohorts using (1) commercial claims and (2) electronic health record (EHR) data from the Excellence Network in Rheumatology to Innovate Care and High-impact research (ENRICH), a community rheumatology practice-based research network. Patient characteristics, treatments and healthcare utilisation were assessed using the 18 months before and 12 months after diagnosis in claims and the 12 months before and after diagnosis in EHR data.ResultsWe identified 2475 patients (claims) and 1196 patients (EHR) with incident DM. Among 998 patients in the EHR cohort with available laboratory data, 472 had available myositis panel results, with 165 (35.0%) having a positive myositis-specific antibody. Glucocorticoid use was common, 68.7% and 73.8% in the two cohorts, respectively, with initial doses most often >20 mg/day; among glucocorticoid users, mean cumulative dose was 1407 mg in the claims cohort. Hydroxychloroquine, methotrexate and mycophenolate were the most commonly used immunomodulatory therapies. During follow-up in the claims data cohort, incidence per 1000 person-years was 92.2, 15.3, 6.4, 2.9 and 2.1 for all-cause hospitalisation, malignancy, interstitial lung disease, gastrostomy tube placement and myocarditis, respectively.ConclusionAdministrative claims and EHR data can be leveraged to assess treatment patterns and longitudinal outcomes/disease manifestations in incident dermatomyositis cohorts. This study highlights a high burden of glucocorticoid exposure, significant heterogeneity in treatment and high healthcare utilisation in this population.