Despite long-standing recommendations,1–3 most gout patients prescribed urate lowering treatment (ULT) do not achieve serum urate (SU) target.4 The time between treat-to-target (T2T) recommendations and achievement of SU treatment target, and how the latter was impacted by the COVID-19 pandemic has not been evaluated. We used UK-wide nationally representative primary-care data from the Clinical Practice Research Datalink (CPRD) GOLD to evaluate temporal trends in achievement of T2T–SU levels within 12 months of first ULT prescription in successive years from 1997 to 2020. CPRD contains anonymised healthcare records from >18 million individuals, originating during their routine care in the National Health Service, a healthcare system with universal coverage.5

This study spanned from 01 January 1997 to 31 December 2021. Prevalent gout cases age≥18 years, first prescribed ULT in the study period was followed from the first prescription to earliest of prescription end, death, transfer out, last data collection, 12 months after ULT prescription or 31 December 2021. Participants were required to have≥1 year ULT prescription-free registration prior to study entry to prevent prevalent ULT users appearing as new users. Gout and ULT prescription status were defined using Read and product codes.6

Prevalence (95% CI) of achieving SU<360 and <300 µmol/L within 12 months of ULT initiation were calculated. The latest SU within 12 months of ULT initiation was used to define achievement of target thresholds. Cox proportional HR with 95% CI …