Trends in gout management before and after publication of NICE guidance in England: a population-based study in OpenSAFELY

In England, ULT initiation after new gout diagnosis rose from 26.6% (July 2016) to 43.0% (June 2025), but the post–June 2022 increase slowed (trend change −0.76 percentage points per year).

• Why it matters: NICE guidance for gout was issued to improve evidence-based care, yet it was unclear whether real-world practice in England changed at scale and how to monitor implementation using routine data.
• What they did: Using an observational cohort with interrupted time-series analysis in 22,618,945 OpenSAFELY participants, investigators tracked ULT prescribing and serum urate target attainment after the June 2022 NICE guideline.
• The result: Among 108,380 people starting ULT, 33.1% achieved at least one serum urate below 360 micromol/L within 12 months, with only modest post-publication improvement (trend change +1.25 percentage points per year), suggesting continuation rather than a guideline-specific effect.

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