LONDON — New data from a randomized trial presented at the 2026 European Alliance of Associations for Rheumatology (EULAR) Congress in London showed that continuing urate-lowering therapy (ULT) in gout patients who had achieved remission was more effective than attempting to discontinue treatment. Over a 24-month period, patients who remained on a treat-to-target (T2T) ULT strategy were more likely to maintain remission and experience fewer disease flares.
The open-label, randomized superiority trial enrolled 309 gout patients in remission across nine rheumatology clinics in the Netherlands. Participants were assigned to either continue ULT under a T2T approach—with dose adjustments guided by serial serum urate measurements—or to attempt discontinuation of ULT. During the final six months of follow-up, 79.2% of patients in the continued ULT T2T group met remission criteria, compared with 62.9% in the ULT discontinuation attempt group.
Cumulative gout flare incidence over the full 24 months was 12.3% in the continued ULT T2T group, less than half the 31.8% observed in the discontinuation group. Patients who stopped ULT also required more anti-inflammatory medication during the trial. In the discontinuation group, 23% of patients restarted ULT after a median of 392 days.
A modest benefit in kidney function was also noted among those who continued ULT during remission. Although current guidelines recommend lifelong ULT in a T2T strategy to maintain remission, evidence supporting its superiority during remission had been lacking until now. Adherence to urate-lowering therapy is often poor in clinical practice, and discontinuation is common.
"These findings support current recommendations to continue ULT during remission at the population level. The results will inform shared decision-making discussions. However, future research will need to explore longer-term outcomes and safety—and predictors of discontinuation success—given that a substantial proportion of patients remained in remission—as well as assessing cost-effectiveness," said Iris Rose Peeters, the study’s lead researcher.