TOPLINE:

The delayed initiation of urate-lowering therapy (ULT) was associated with poorer control of serum urate levels in patients with gout. Despite more than 60% of patients receiving ULT, less than 13% achieved good serum urate control, with levels less than 6 mg/dL for at least 80% of the time.

METHODOLOGY:

• Researchers conducted a retrospective population-based cohort study using data from a primary care database in Spain and included 94,759 individuals with incident gout diagnosed between 2012 and 2023.
• Data on demographics, comorbidities, and ULT were collected; ULT drugs included allopurinol and febuxostat.
• Primary outcomes were serum urate control and adherence to ULT, assessed over a median follow-up duration of 5.44 years.
• Good serum urate control was defined as serum urate levels less than 6 mg/dL for at least 80% of the follow-up time; serum urate control was categorised as null control (never), poor control (less than 50%), moderate control (50%-80%), and good control (at least 80%).
• Adherence was assessed using the medication possession ratio (MPR), reflecting the percentage of time patients had medication gaps (< 90 days without treatment), with good adherence defined as the MPR ≥ 80%, and factors associated with good serum urate control were analysed.

TAKEAWAY:

• Overall, 62.70% of patients were dispensed ULT. Allopurinol was the initial therapy in 96.1% of treated patients, with 3.5% subsequently switching to febuxostat. Treatment prevalence remained stable throughout the follow-up period, ranging from 25.3% to 31.7%, whereas the initiation of treatment declined from 27.9% to 12.6%.
• Good adherence was achieved by only 6%-8% of all patients, and good control of serum urate levels was achieved by 12.40%. Serum urate levels less than 6 mg/dL were achieved by 53.4% at least once during follow-up, and the levels remained below this threshold for a median of 47.8% of their total follow-up time.
• Factors such as male sex, higher BMI, obesity, hypertension, dyslipidaemia, ischaemic heart disease, and alcohol abuse were linked to poorer serum urate control, whereas cerebrovascular disease, type 2 diabetes, longer treatment duration, higher allopurinol doses, and febuxostat therapy were correlated with better control.
• In multivariate analysis, better adherence was associated with improved serum urate control, whereas delayed treatment initiation was associated with poorer control.

IN PRACTICE:

"Our findings suggest that long-term serum urate control in gout is less influenced by external socioeconomic factors or healthcare system accessibility than by treatment-related aspects. We observed no relevant differences according to socioeconomic status, follow-up duration, or frequency of laboratory testing, pointing instead to undertreatment and therapeutic inertia as key contributors to suboptimal control," the authors wrote.

SOURCE:

This study was led by Maria Antonia Pou, MD, Encants Primary Health Care Center, Barcelona, Spain. It was published online on June 04, 2026, in the British Journal of General Practice.

LIMITATIONS:

The misclassification of gout diagnosis was possible as this was an electronic medical record-based study. Data on gout flares, quality of life, the use of diuretics or other drugs potentially affecting levels of serum urate, and mortality outcomes were lacking. The median follow-up duration was 5 years, which may have underestimated long-term management dynamics.

DISCLOSURES:

One author received funding from Catalan Institute of Health/Institut Universitari d'Investigació en Atenció Primària Jordi Gol for this study. Statistical work was supported by Asacpharma, which funded the work of data technicians. The authors did not declare any competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.