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LONDON — Continuing a urate-lowering therapy (ULT) treat-to-target (T2T) strategy is better than trying to discontinue ULT in people whose gout has gone into remission, according to the results of the GO TEST Finale trial.

In the last 6 months of a 2-year follow-up period, more than three quarters (79%) of the 155 participants treated with the ULT T2T strategy were in remission, compared with 63% of the 154 participants who had been randomly assigned to a ULT discontinuation attempt strategy. The 16% risk difference was highly significant at P = .0015.

Moreover, significantly more people in the ULT T2T continuation than in the attempted ULT discontinuation arm of the study were free of gout flares during 18-24 months (99% vs 89%; P < .001), and more had a low pain score due to gout (86% vs 77%; P = .037), defined as < 2 on a 0-10 numerical rating scale (NRS).

These findings were consistent with European and American guidance that ULT T2T should be continued for life even when remission from gout has been achieved, Iris Rose Peeters, MSc, and colleagues reported at the European Alliance of Associations for Rheumatology (EULAR) 2026 Annual Meeting.

Peeters, who works at Sint Maartenskliniek in Nijmegen, Netherlands, said during the abstract plenary held on the opening day of the meeting: “A prolonged follow-up up to 5 years is now underway, which will tell us more about the long-term outcomes.”

Additional analyses, including cost effectiveness, were being performed, and “perhaps in the future, after in-depth subanalysis, personalization could be possible,” she added, noting that results of proteomic, genomic, and imaging studies were pending. The value of other discontinuation strategies also needed to be established, such as in the ongoing STING (Stop Treatment in Gout) trial.

GO TEST Finale

GO TEST Finale was “a pragmatic, open-label, randomized, multicenter, superiority trial,” Peeters said. A total of 309 adults with gout who had been in remission for at least 1 year while taking ULT were recruited across nine Dutch rheumatology clinics between 2021 and 2023. Remission was defined as having no flares of disease or clinical tophi, a serum urate level of 0.36 mmol/L (6 mg/dL) or lower in the past 12 months, and low gout pain and patient-reported gout disease activity scores, both defined as a score < 2 out of 10 on an NRS.

After inclusion, participants were randomly allocated to either continue their ULT to maintain a serum urate target of 0.36 mmol/L or to a ULT discontinuation attempt strategy. The latter involved stopping the ULT but reinstating it if there was a disease flare after 7 days or more, more than one disease flare, or if tophi developed.

The majority (94%) of participants were men, and the median age was 68 years in the ULT T2T continuation arm and 67 years in the ULT discontinuation attempt arm. Similar percentages had comorbidities, such as hypertension (59% and 50%, respectively) and diabetes (19% and 18%, respectively).

Peeters pointed out that participants in both study arms had a serum urate level of 0.28 mmol/L at inclusion and that the majority (90%) had been treated with allopurinol. Only a few in each arm had been treated with benzbromarone or febuxostat.

Secondary Endpoint Results

Using simplified gout remission criteria of having no gout flares in the final 6 months of the 2-year follow-up period or no tophi across the entire follow-up period, Peeters reported that 98.6% of people continuing and 86.4% of those discontinuing ULT were in remission at 2 years, with a significant risk difference of 12.2% (P < .001).

A higher percentage of those in the continuation arm (75%) compared with the discontinuation arm (59%) were flare-free at 2 years.

Just two (1.3%) of the participants in the continuation group discontinued ULT, whereas 35 (23%) of those in the discontinuation group restarted ULT treatment. The median time to restarting ULT in this arm was just over 1 year (392 days).

Significantly fewer participants in the continuation arm than discontinuation arm took anti-inflammatory medication at any time during the study (18% vs 36%).

“Five deaths occurred during the study period, which were deemed not related to the study procedures,” Peeters said.

There were similar numbers of cardiovascular events in the continuation (n = 12) and discontinuation (n = 10) arms, she added.

“However, we did find that kidney function over 24 months showed a significant lower decline in the ULT continuation strategy compared to the discontinuation group,” Peeters said.

Thoughts From the Audience

Although flare-free survival was higher in the continuation than in the discontinuation arm, one delegate said that the rates in the latter were still considerable and it would be interesting to see why some people in the discontinuation arm did not flare when others did.

Another said: “I think we’re all probably a little surprised at the relatively small risk difference” in people who remained in remission with the continuation over the discontinuation strategy.

“The question would be, is there a subgroup in which [rates] look much more similar? In particular, was the duration on therapy possibly associated and was longer duration [of ULT] associated with less likelihood of having a worse outcome with discontinuation?”

Peeters responded that participants in both arms had been living with a diagnosis of gout for at least 7 years before entering the study.

“I think what is most important [is] that there’s an extension [phase] on the way, which will tell us more about the long-term outcomes,” she said.

The study was funded by the Dutch Appropriate Use of Medicines program (ZonMw). Peeters reported having no relevant conflicts of interest.

Sara Freeman, MSc, is a freelance medical journalist based in London, England. She has been reporting for specialist healthcare news organizations for more than 20 years.