Time Trends and Predictors of Gout Remission

In a 6-year post hoc analysis of the CARES trial, gout remission on urate-lowering therapy (ULT) increased from 37.4% in year 1 to 63.1% in year 6. Overall, 59.4% of patients achieved remission at least once during follow-up, investigators reported in Arthritis Care & Research.

Remission was defined using simplified 3-domain criteria: no gout flares over the past year, at least 2 serum urate measurements <0.36 mmol/L during the past year, and absence of tophi. The analysis included participants from the CARES trial with at least one year of follow-up. Logistic regression identified baseline predictors of remission.

Febuxostat recipients had higher remission rates than allopurinol recipients over the initial 2 years, driven largely by better achievement of serum urate targets.

Multivariable analysis revealed that older age and febuxostat use were positively associated with remission. Conversely, Black race, longer disease duration (>10 years), presence of tophi, elevated baseline serum urate, and comorbidities—including diabetes, cerebrovascular disease, and heart failure—were associated with lower likelihood of remission.

These findings suggest that a majority of patients treated with ULT can achieve remission, but early and proactive management is crucial, especially in populations with risk factors for poor remission. Febuxostat may offer an advantage in achieving serum urate targets early. Persistent disparities by race and comorbidity burden highlight the need for tailored interventions to promote equitable outcomes.

Reference:

Tabi-Amponsah AD, Stewart S, Gamble G, Stamp LK, Taylor WJ, Dalbeth N. Time trends and predictors of gout remission over six years. Arthritis Care Res. Published online June 18, 2025. doi:10.1002/acr.25584