Understanding gout management patterns among primary care physicians: systematic literature review and analysis

 

Paul Doghramji, Richard Lai, Alexis Woods, Salvador Brito, Niranjan Kathe, And Brian Lamoreaux

 

Affiliation(s):

Amgen, Inc.

 

 

Introduction: Despite gout being a common and treatable disease, evidence points to major gaps in guideline adherence and suboptimal patient outcomes among primary care physicians (PCPs) [1]. This study leveraged systematic literature review (SLR) findings to assess PCPs’ awareness of gout management guidelines, prescribing practices for urate-lowering therapies (ULTs), serum urate monitoring, and patient outcomes, globally, to identify predictors of suboptimal management and areas for improvement.

Methods: A SLR was conducted using an AI-driven approach leveraging MEDLINE and PubMed Central, supplemented by manual searches. Studies were screened using PICOS criteria and inclusion focused on PCP practice audits, physician surveys and interviews, and observational studies evaluating PCPs’ gout management practices globally published between 2000 and 2024. Parameterized outcomes included ULT prescribing and dosing, serum urate monitoring practices, and PCP awareness of local guidelines published by rheumatology societies, including serum urate monitoring and targets. Data extraction was conducted based on predefined outcomes and findings were synthesized into narrative and tabular summaries.

Results: 291 publications were identified, of which 50 were included. The final list of publications consisted of 27 audits, 15 surveys, 6 interviews, and 2 prospective observational studies. Gout guideline awareness ranged from 11-68% across surveyed PCPs; awareness of individual aspects of gout management such as ULT use (i.e. identification of allopurinol as a ULT agent, knowledge to use allopurinol 1st line) and recommended serum urate targets (<6 mg/dL target) was comparable to overall gout guideline awareness (Table 1). ULT prescribing by PCPs varied significantly across time, with % of patients receiving ULT prescriptions ranging from 19-83% across audits analyzed (Fig. 1A). The % of      patients on 100mg and 300mg at time of audit ranged from 13-38% and 23-60%, respectively (Fig. 1B). Serum urate monitoring rates varied widely, with median rates of 56% and 42% for one-time and serial (<6 month intervals) monitoring, respectively. Analysis over time suggests that monitoring may be increasing in recent years (Fig. 2A, B). Despite increased awareness of local gout guidelines published by rheumatology societies and increased frequency of serum urate monitoring seen in recent years, the % of patients achieving serum urate targets (<6 mg/dl) has been decreasing over time (pre 2012 median: 59%, post 2012 median: 32%; Fig. 2C).

Conclusions: Our findings indicate that there is inconsistent awareness of and adherence to gout management recommendations among PCPs. Despite encouraging trends in serum urate monitoring, the declining rates of patients achieving a serum urate target <6mg/dl may reflect under-prescribing of ULTs and inadequate dose titration. This study further adds to the existing literature on the factors that contribute to variations in care and suboptimal patient outcomes and highlights the need for continued improvement in gout awareness, education, and treatment strategies among PCPs.

References

Jeyaruban A, et al. Clin Rheumatol 2015;34:9-16.