# Comparative Effectiveness of Treat-To-Target Approach versus Routine Care in Management of Gout

> **NIH NIH R01** · BRIGHAM AND WOMEN'S HOSPITAL · 2020 · $435,018

## Abstract

Gout is a highly prevalent, painful inflammatory arthritis, caused by crystallization of uric acid in joint
tissues. Gout flares cause impaired quality of life and physical function, leading to lost work days, disability,
high healthcare costs. Patients with gout are also known to be at an increased risk of cardiovascular diseases
(CVD), kidney disease, and mortality. Previous studies suggest a potential beneficial effect of urate-lowering
therapy on the risk of CVD and renal function. Over the past decade, the American College of Rheumatology
and the European League Against Rheumatism recommend a treat-to-target (TTT) approach that lowers
serum uric acid (SUA) level below 6 mg/dl to reduce acute gout attacks, based on the upper limit of water
solubility of uric acid under normal physiologic circumstances. However, the 2016 American College of
Physicians (ACP)’ guidelines for gout management recommend use of urate-lowering therapy but support a
‘treat-to-avoid symptoms’ strategy without monitoring SUA rather than the TTT strategy because of
‘inconclusive’ evidence in the literature. Such discrepancies in treatment guidelines from various societies urge
the need for comparative effectiveness research of the treatment strategies for gout.
 Rigorous epidemiologic studies utilizing high-quality observational data from electronic health records
(EHR) or insurance claims databases can be an important tool for comparative effectiveness research. The
primary objective of this 3-year proposal is to provide high-quality, timely evidence on the comparative
effectiveness of two different treatment strategies, TTT versus usual care, for management of gout. We will
pursue this objective by utilizing the linked Partners’ EHR-Medicare database (2007-2016); this linked
database includes all patients aged ≥65 years enrolled in Medicare Parts A/B/D who had ≥1 encounter at one
of the Partners Healthcare hospitals. We will have longitudinal, clinically important data on patients’
demographics, body mass index, visit notes, laboratory results including SUA and serum creatinine, as well as
all Medicare claims for inpatient and outpatient visits, procedures, and prescription drugs. The two specific
aims of this 3-year proposal are: 1) to examine the effect of TTT strategy on the risk of gout flares versus usual
care and 2) to assess the effect of TTT strategy on the risk of kidney disease and CVD versus usual care.
 Given the substantial prevalence of gout, the suboptimal management of gout and lack of comparative
trial of different treatment strategies, this proposed study will make an immediate, important contribution to the
management of gout in clinical practice. This work will not only investigate the effects of different treatment
strategies on gout flares but also on common comorbidities in patients with gout such as kidney and CVD.
Furthermore, this proposed study will advance understanding of how to improve ascertainment of dynamic
outcomes and control for time...

## Key facts

- **NIH application ID:** 9975704
- **Project number:** 5R01AR073314-02
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Seoyoung Catherine Kim
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $435,018
- **Award type:** 5
- **Project period:** 2019-07-10 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9975704

## Citation

> US National Institutes of Health, RePORTER application 9975704, Comparative Effectiveness of Treat-To-Target Approach versus Routine Care in Management of Gout (5R01AR073314-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9975704. Licensed CC0.

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