Current EULAR and American College of Rheumatology (ACR) guidelines recommend lifelong urate-lowering therapy (ULT) using a treat-to-target (T2T) strategy for maintaining gout remission.¹ However, evidence comparing continued T2T ULT with ULT discontinuation in gout remission remains unclear.¹ At the EULAR 2026 Congress, Professor Iris Rose Peeters from Sint Maartenskliniek, Netherlands, presented the 2-year results of the pragmatic, open-label, randomized GO-TEST FINALE trial, demonstrating that continued T2T ULT was superior to ULT discontinuation for maintaining gout remission.¹

The multicenter trial enrolled patients with a clinical diagnosis of gout or who fulfilled the 2015 ACR/EULAR gout classification criteria, who had been receiving ULT and remained in remission for ≥12 months, defined by no flares or clinical tophi, serum urate ≤0.36mmol/L, gout pain score <2, and gout disease activity score <2.¹ Key exclusions included clinically visible tophaceous gout, contraindications to standard gout therapies, regular use of gout medications for symptom prevention or treatment, or recent major cardiovascular disease.¹

Patients were randomized 1:1 to either continued T2T ULT targeting serum urate < 0.36 mmol/L or an attempt at ULT discontinuation.¹ In the discontinuation group, ULT was restarted if patients developed a flare lasting >7 days, >1 flare, or tophi.¹ The primary endpoint was modified gout remission during Months 18-24, defined by no flares or clinical tophi, gout pain score <2, and gout disease activity score <2.¹ Key secondary outcomes included flare-free survival, ULT and anti-inflammatory medication use, and adverse events.¹

A total of 310 patients were randomized, with 309 included in the intention-to-treat analysis (155 in the ULT T2T continuation group and 154 in the discontinuation group).¹ The study population was predominantly male, with a median age of 68 years in the continuation group and 67 years in the discontinuation group.¹ Baseline characteristics were generally comparable, although hypertension and previous cerebrovascular or transient ischemic events were more frequent in the continuation group.¹ Approximately 85% of patients fulfilled the ACR/EULAR gout classification criteria, and allopurinol was the most commonly used ULT.¹

The primary endpoint significantly favored continued T2T ULT, with 79% of patients in the continuation group remaining in remission vs. 63% in the discontinuation group (risk difference=16%; 95% CI: 6-26; p=0.0015).¹ Using simplified remission criteria, remission rates were 98.6% versus 86.4%, respectively (risk difference=12.2%; 95% CI: 6.3-18.1; p<0.001).¹ Flare-free survival was also significantly higher with continued ULT (p<0.001).¹

ULT discontinuation led to more frequent therapy restarts vs. T2T ULT (23% vs. 1.3%), with a median time to restart of 392 days.¹ Anti-inflammatory medication use was also lower with continued ULT (18% vs. 36%; 95% CI: -27 to -8; p<0.001).¹

Five deaths occurred during the study, with three in the continuation group and two in the discontinuation group, while rates of major non-fatal cardiovascular events remained similar between groups.¹ Notably, kidney function declined significantly less over 24 months with continued T2T ULT, with a baseline-adjusted mean difference in estimated glomerular filtration rate of -1.84mL/min/1.73m² (95% CI: -3.52 to -0.15; p=0.033).¹

In conclusion, the GO-TEST FINALE trial demonstrated that continued T2T ULT was superior to ULT discontinuation for maintaining gout remission over 2 years.¹ Continued ULT was associated with fewer flares, lower use of anti-inflammatory medication, and a smaller decline in kidney function, supporting continued T2T management in patients with sustained gout remission.¹