ATLANTA – The American College of Rheumatology (ACR) is previewing draft recommendations from an updated treatment guideline for managing patients with gout during the 2019 ACR/ARP Annual Meeting in Atlanta. Several clinical trials have been conducted that provide additional evidence regarding the management of patients with gout since the ACR last released a treatment guideline for the condition in 2012, leading the ACR Practice Guidelines Subcommittee to determine that updated recommendations were warranted.
“The updated guideline provides clinicians with evidence-based guidance on important topics such as the optimal usage of urate-lowering therapy (ULT), treatment of gout flares, managing lifestyle factors and other medication recommendations to help them be successful in optimally managing gout in their patients,” said Dr. Tuhina Neogi, one of the co-principal investigators on the treatment guideline.
Dr. Neogi will discuss the draft recommendations at a press conference on Tuesday, Nov. 12, at 1:30 pm ET in Room B202 of the Georgia World Congress Center, as well as at a session during the meeting program with her fellow co-principal investigator, Dr. John FitzGerald:
- Gout Management: New ACR Clinical Guideline (Wednesday, Nov. 13, 11am – 12:30pm)
One of the key elements of the new draft guideline includes a strong recommendation to use a treat-to-target strategy with ULT for all patients with gout, based on data from newer clinical trials. The draft guideline suggests a management strategy of starting with a low-dose of a ULT medication and escalating the dosage to achieve and maintain a serum urate level of less than 6 mg/dL to optimize patient outcomes over a fixed-dose strategy. This strategy mitigates the risk of treatment-related adverse effects (e.g., hypersensitivity), as well as flare risk accompanying ULT initiation.
“While the recommendation differs from the American College of Physicians, a treat-to-target approach was supported by randomized trial data, so we hope this will change how health care providers currently treat the condition,” said Dr. Neogi. “Gout management remains largely suboptimal due to many providers only managing flares without also treating the underlying hyperuricemia that causes gout or starting a patient on a urate-lowering therapy medication without escalating the dose or monitoring the serum urate response to guide dose escalation.”
Some of the other changes between the 2012 guideline and the current draft include:
- A strong recommendation to use allopurinol as the first-line urate-lowering therapy, including in patients with chronic kidney disease.
- A strong recommendation to use an anti-inflammatory prophylaxis (e.g., colchicine, NSAIDs, prednisone/prednisolone) when starting ULT for at least 3-6 months rather than less than 3 months, with ongoing evaluation and continued prophylaxis as needed if the patient continues to experience flares.
- Indications for starting ULT have been expanded to conditionally consider patients with infrequent gout flares or after their first gout flare if they also have moderate to severe chronic kidney disease (CKD stage ≥ 3), marked hyperuricemia (serum urate > 9 mg/dl) or kidney stones.
- A conditional recommendation for HLA-B*5801 testing prior to starting allopurinol for patients of Southeast Asian descent (e.g., Han Chinese, Korean, Thai) and African-American descent who have a higher prevalence of HLA-B*5801 and against HLA-B*5801 testing in patients of other ethnic or racial backgrounds.
- A conditional recommendation for an augmented protocol of ULT dose management by non-physician providers to optimize the treat-to-target strategy.
The manuscript containing the full list of recommendations and supporting evidence is currently under peer review and is expected to be published in early 2020.
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About the ACR/ARHP Annual Meeting
The ACR/ARP Annual Meeting is the premier meeting in rheumatology. With more than 450 sessions and thousands of abstracts, it offers a superior combination of basic science, clinical science, tech-med courses, career enhancement education and interactive discussions on improving patient care. For more information about the meeting, visit https://www.rheumatology.org/Annual-Meeting, or join the conversation on Twitter by following the official hashtag (#ACR19).
About the American College of Rheumatology
The American College of Rheumatology (ACR) is an international medical society representing over 8,500 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases. For more information, visit www.rheumatology.org.
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