Rapid and Regular Dose Escalation in Urate Lowering Therapy: A Retrospective Cohort Study

Background Gout management faces the key clinical challenge of balancing the risk of disease flares with timely achievement of serum uric acid targets—critical for preventing long-term joint damage and improving patient outcomes. This study aimed to evaluate the risks and benefits of rapid versus regular dose escalation strategies for urate-lowering therapy, to inform optimized balancing of these two goals. Methods This single-center retrospective study analyzed real-world clinical data from a specialized gout clinic (January 2019-October 2024). Gout patients were stratified into rapid group (dose adjustment within half month of treatment initiation) and regular group (dose adjustment at one month) according to their urate lowering treatment records. They primary outcome was post-escalation flare rate. Secondary outcomes included urate target achievement rate and time to reach the target. Results A total of 170 patients were included: 87 (51.2%) patients (median 39 [range 30 ~ 44] years; male percentage of 97.7%) in the rapid group and 83 (48.8%) patients (median 37 [range 31 ~ 52] years; male percentage of 97.6%) in the regular group. The post-escalation flare rate was higher in the rapid group (39.1% vs. 24.1%, P  = 0.036) but not statistically significant after multivariate adjustment (odds ratio = 0.91, P  = 0.853). The serum uric acid target achievement rate was similar between groups (60.9% vs. 61.4%, P  = 0.944), but the rapid group had a significantly shorter time to target (median 2.02 vs. 3.43 months, P  = 0.018) and a higher likelihood of target attainment (adjusted hazard ratio = 1.73, P  = 0.007). Conclusions Both rapid and regular dose escalation strategies effectively achieve serum uric acid targets. Clinicians and patients should jointly decide on an individualized urate lowering protocol after discussing the risks and benefits of each strategy to align with individual needs. Trial registration Chinese Clinical Trial Registry (ChiCTR2300078472, registration date: 2023-12-8)