Journal Article

POS0569 CARDIOVASCULAR DISEASE, CHRONIC KIDNEY DISEASE, PAIN, AND PSYCHOLOGICAL ISSUES IN PATIENTS WITH CONTROLLED VS. UNCONTROLLED GOUT: A RETROSPECTIVE CLAIMS-BASED COHORT ANALYSIS

Zhu, K., Grewal, S., Padnick-Silver, L., Lamoreaux, B., Meyers, A., Lai, R. H., Gray, S.

2024

Overview

Background:It is well known that gout patients have higher comorbidity burden,[1] health resource utilization (HRU),[2] cardiovascular mortality,[3] and all-cause mortality[4] than their non-gout counterparts. Gout also negatively impacts patient quality of life (QOL), with acute gout flare frequency and pain heavily contributing.[5] The literature comparing controlled and uncontrolled gout is sparse, but one study found higher health burden in patients with uncontrolled gout,[6] including chronic kidney disease (CKD) and cardiovascular disease (CVD).Objectives:To examine the prevalences and incidences of CVD and CKD in patients with controlled and uncontrolled gout. Prevalences of pain and mental health issues were also estimated to better understand impact on patient well-being.Methods:The Merative™ MarketScan® Research Databases (closed claims data, commercially-insured patients; 2015-2023) were used. Index date was defined as the date of gout diagnosis, defined as the earliest date of first tophi code, second flare occurrence, first emergency department (ED) visit for gout, or first gout-related hospitalization. All patients were also required to be ≥18 years of age at study index and to have ≥1 gout diagnosis code (ICD-10 M10.*) in the 12-month prior to the index date (baseline). Patients were classified as having controlled gout if no gout symptoms (tophi, flare, ED/hospital visit) were noted in the 12-month pre-index period and last pre-index serum urate level (SU) was <6 mg/dL. Patients were classified as having uncontrolled gout if they had elevated SU prior to index (last pre-index SU of ≥8 mg/dL or pre-index SU ≥6 mg/dL for 3-months) and gout symptoms (≥1 tophi code in 12-month pre-index period, ≥2 gout flares, or ED visit/‌hospitalization for gout) with ≥360 days of oral urate-lowering therapy (ULT) use. CVD was identified as any code for Disease of the Circulatory System (I00-I99, included hypertension). CKD was identified with unspecified/staged CKD codes (N18.*).Results:2697 controlled (81% male, 60.5±12.5 years, SU: 5.13±1.17 mg/dL) and 2435 uncontrolled (83% male, 56.8±13.4 years, SU: 8.45±1.70 mg/dL) patients were identified (in database 2.4±1.5 years before index, 2.5±1.5 years after index). Despite being younger, CKD and CVD were slightly more prevalent in uncontrolled patients (CKD: 25% vs. 20%; CVD: 82% vs. 79%) at gout diagnosis. After gout diagnosis, those with uncontrolled vs. controlled gout more often had an outcome of nonfatal stroke (9.7% vs. 6.5%) and myocardial infarction (3.9% vs. 1.8%, both p<0.001) and a higher incidence of stroke (31.5 vs. 28.8/1000PY), ischemic cardiac disease (48.7 vs. 39.0/1000PY), and heart failure (32.4 vs. 21.0/1000PY; all p<0.001). Uncontrolled patients also seemed more affected by gout, with higher prevalence of pain and psychological issues at diagnosis (pain: 48% vs. 23%; psychological: 25% vs. 17%; both p<0.001). Health resource utilization and associated costs of controlled and uncontrolled gout will also be explored.Conclusion:This study provides further evidence that comorbidity, pain, and mental health burdens are high in gout patients, but even higher in those with uncontrolled disease. Further, incidence of stroke, heart failure, and ischemic cardiac disease was high in the gout population a mean of 2 years after gout diagnosis, with even higher incidence in uncontrolled patients. These findings emphasize the importance of gout control for overall patient health and well-being.REFERENCES:[1] Kuo CF, et al. Ann Rheum Dis. 2016;75:210-7.[2] Trieste L, et al. 2012;30:S145-8.[3] Kuo CF, et al. Rheumatology (Oxford). 2010;49:141-6.[4] Vincent ZL, et al. J Rheumatol. 2017;44:368-73.[5] Watson L, et al. Rheumatology (Oxford). 2023;62:2748-56.[6] Francis-Sedlak M, et al. Rheumatol Ther. 2021;8:183-97.Acknowledgements:NIL.Disclosure of Interests:Richard HC Lai Abbvie, Amgen, Glaxo Smith Kline, Horizon (now Amgen, Inc.), Mallinckrodt, and Pfizer, Suneet Grewal Glaxo Smith Kline, Horizon (now Amgen, Inc.), and UCB, Horizon (now Amgen, Inc.), Kaiding Zhu Amgen, Inc., Amgen, Inc., Stephani Gray Amgen, Inc., Andrea Meyers Amgen, Inc., Amgen, Inc., Lissa Padnick-Silver Amgen, Inc., Amgen, Inc., Brian LaMoreaux Amgen, Inc., Amgen, Inc..

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier B.V,Elsevier Limited
• Subject: Cardiovascular disease / Cardiovascular diseases / Cerebral infarction / Chronic pain / Circulatory system / Comorbidities / Comorbidity / Congestive heart failure / Coronary artery disease / Diagnosis / Emergency medical care / Gout / Health services utilization / Heart diseases / Heart failure / Ischemia / Kidney diseases / Mental disorders / Mental health / Mortality / Myocardial infarction / Pain / Patients / Quality of life / Real-world evidence / Resource utilization / Rheumatology / Scientific Abstracts / Stroke / Uric acid / Well being