# Improvements in Health‐Related Quality of Life With Treat‐to‐Target Urate‐Lowering Therapy in Gout: A Post Hoc Analysis of a Randomized Multicenter Trial

## TL;DR

Treat-to-target urate-lowering therapy for gout significantly improves health-related quality of life, especially in physical function and pain, within 24 weeks and lasting up to 72 weeks.

## Contribution

This study provides new evidence that treat-to-target urate-lowering therapy improves health-related quality of life in gout patients over time.

## Key findings

- HRQoL scores improved significantly by 24 weeks and remained improved through 72 weeks of treat-to-target ULT.
- Improvements were most notable in physical function, mobility, and pain domains.
- Lower baseline inflammation and comorbidity were linked to greater HRQoL improvements.

## Abstract

Although treat‐to‐target urate‐lowering therapy (ULT) is endorsed as best practice in gout management, limited data exist on its impact on health‐related quality of life (HRQoL). We assessed the impact of treat‐to‐target ULT on HRQoL among participants receiving protocolized gout care, identifying factors associated with HRQoL and HRQoL change.

This was a post hoc analysis of a 72‐week randomized trial, pooling data from allopurinol and febuxostat treatment arms. The Veterans RAND‐12 Item Health Survey and EuroQol 5‐Dimension 3‐Level (EQ‐5D‐3L) were administered at baseline and at 24, 48, and 72 weeks. HRQoL changes over follow‐up were examined using paired t‐tests. Factors associated with baseline HRQoL were evaluated using multivariable linear regression. General estimating equations were used to identify determinants of HRQoL change over follow‐up.

Participants (N = 878) in this analysis were 98.9% male, had a mean age of 62.4 years, and 67.4% self‐reported White race. HRQoL scores overall, and particularly the domains of physical function, mobility and pain, improved significantly over 72 weeks (P < 0.001) with improvements noted by 24 weeks. Poorer enrollment HRQoL was associated with younger age, non‐White race, tophi (for EQ‐5D‐3L), higher serum urate level, and greater comorbidity. Baseline factors associated with HRQoL improvements over 72 weeks of ULT included lower C‐reactive protein level and lower comorbidity scores with similar changes observed by ULT assignment.

Treat‐to‐target ULT in gout is accompanied by HRQoL improvements evident by 24 weeks and sustained through 72 weeks. HRQoL gains with treat‐to‐target ULT are most prominent in the domains of physical function, mobility, and pain and are greatest in those with lower baseline levels of inflammation and comorbidity.