CONTINUED urate-lowering therapy (ULT) in a treat-to-target (T2T) strategy is favourable in patients with gout compared with ULT discontinuation attempts, according to new data presented today at EULAR 2026, London, UK.
The open-label, randomised superiority trial, ran across nine rheumatology clinics in the Netherlands, analysed 309 patients with gout and assessed continuation of T2T with ULT against ULT discontinuation attempts.
Current Guidelines
In clinical practice, adherence to ULT is often poor and discontinuation is common.
Current guidelines recommend lifelong ULT in a T2T strategy to maintain remission.
There is some scope for discussing tapering or discontinuation if remission is achieved.1-3
Data Presented at EULAR 2026
Results of the trial showed that during the final 6-month follow-up period (from a total of 24 months), a substantial proportion of patients remained flare-free after ULT discontinuation.
Remission criteria were met in 79.2% of the continued ULT T2T group compared with 62.9% of the ULT discontinuation attempt group.
Patients continuing ULT remained flare-free for longer over 24 months, with a cumulative flare incidence of 12.3% compared with 31.8% in the ULT discontinuation attempt group.
In the discontinuation attempt group, 23% restarted ULT after a median of 392 days and more participants needed anti-inflammatory medication compared with the ULT T2T group.
There was also a modest kidney function benefit observed with ULT T2T continuation during remission.
Iris Rose Peeters, Sint Maartenskliniek, Ubbergen, the Netherlands, said: “These findings support current recommendations to continue ULT during remission at the population level.
“The results will inform shared decision-making discussions.
“However, future research will need to explore longer-term outcomes and safety – and predictors of discontinuation success – given that a substantial proportion of patients remained in remission – as well as assessing cost-effectiveness.”
References
1 Richette P et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis 2017;76:29–42.
2 FitzGerald JD et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res 2020;72:744–60.
3 Kiltz U et al. Treat-to-target (T2T) recommendations for gout. Ann Rheum Dis 2017;76(4):632–8.
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