A treat-to-target strategy versus symptom-driven management of gout in the Netherlands (GO TEST Overture): a multicentre, open-label, pragmatic, superiority, randomised controlled trial

Moses, A; Oude Voshaar, MAH; van Geel, EH; Schipper, L; Peeters, IR; Bos, R; van Durme, C; van de Laar, MAFJ; Jansen, TL

doi:10.1016/s2665-9913(26)00034-2

Gout & crystal arthritis

A treat-to-target strategy versus symptom-driven management of gout in the Netherlands (GO TEST Overture): a multicentre, open-label, pragmatic, superiority, randomised controlled trial

Lancet RheumatolPublished 19 Mar 2026Randomised controlled trial

An erratum to this article was published (Lancet Rheumatol, Oct 2026 ↗)

Primary result · RemissionResultAbsolute difference 15.4 percentage points 95% CI 6.4–24.4

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Authors' conclusion

A treat-to-target strategy was associated with improved long-term disease control compared with symptom-driven care, without evidence of increased adverse events.

Study context

Population: Adults (≥18 years) with gout and hyperuricaemia not currently using ULT, eight secondary care rheumatology centres in the Netherlands268 (87%) male
Participants: 308 adults

Comparison: Treat-to-target serum urate-guided ULT titration (target <0.36 mmol/L) vs symptom-driven management
Treat-to-targetn = 145
Symptom-driven managementn = 163reference
Primary endpoint: Remission: no gout flares during months 18-24, no subcutaneous tophi at month 24, patient-reported pain score <2, and patient global assessment of disease activity score >8
Follow-up: Months 18-24

Methodological detailsmulticentre, open-label, pragmatic, superiority, Participants and investigators not masked, People with lived experience of gout contributed to study design and outcome selection

Multicentre
Open-label
Pragmatic
Superiority
Participants and investigators not masked
People with lived experience of gout contributed to study design and outcome selection

Primary result

Remission

Absolute difference

15.4 percentage points

95% CI 6.4–24.4

P = 0.024

Events by treatment group

Treat-to-target39.4%57 of 145

Symptom-driven management24.0%39 of 163

Treat-to-targetvs Symptom-driven management

absolute difference 15.4 percentage points (95% CI 6.4–24.4); P = 0.024

As reported in the abstract

Safety

Outcome	Treat-to-target	Symptom-driven management	← Lower with treat-to-target ←→ Higher with treat-to-target →	Absolute difference (percentage points) (95% CI)	P value
Adverse events	42%	53%	−30−20−10010	−10.7 (−21.8 to 0.4)	P = 0.060
			−30−20−10010Difference, percentage points (linear scale)

Serious drug-related adverse events and treatment-related deaths

None reported

Reference

Authors: Moses A, Oude Voshaar MAH, van Geel EH, Schipper L, Peeters IR, Bos R, et al.
All 9 authors
Moses A, Oude Voshaar MAH, van Geel EH, Schipper L, Peeters IR, Bos R, van Durme C, van de Laar MAFJ, Jansen TL
Journal: The Lancet Rheumatology
Published: 19 Mar 2026
DOI: 10.1016/s2665-9913(26)00034-2
PubMed: 41865749
Registration: EudraCT 2020-005721-82

Topic: Gout & crystal arthritis

Intervention details

Treat-to-target: target serum urate <0.36 mmol/L with structured serum urate-guided titration of oral ULT (first-line allopurinol; second-line oral febuxostat or oral benzbromarone)
Symptom-driven management: physicians and patients decided whether to initiate ULT based on symptoms; type and dose at physician's discretion without a specific serum urate target

Key notes

ITT with multiple imputation

Original publication

A treat-to-target strategy versus symptom-driven management of gout in the Netherlands (GO TEST Overture): a multicentre, open-label, pragmatic, superiority, randomised controlled trial. Lancet Rheumatol. Published 19 March 2026. doi:10.1016/s2665-9913(26)00034-2

Read the original article ↗

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