Allopurinol Dose Escalation and Mortality Among Patients With Gout

Abstract

This is the largest study to date to investigate the effects of allopurinol use on mortality and is the first to use a rigorous active-comparator design. Dose escalation was associated with a small (<10%) increase in all-cause mortality, thus showing that a strategy of allopurinol dose escalation, which in current real-life practice is characterized by limited dose increases, is unlikely to improve the survival of patients with gout.

Failure to reach uric acid target of <0.36 mmol/L in hyperuricaemia of gout is associated with elevated total and cardiovascular mortality

“…Finally, the design was not that of a clinical trial, and treatment may be driven by extraneous factors, and even by the availability of medications (benzbromarone was not available for some periods of time, then was second line after allopurinol, finally febuxostat became available in 2010). Others have used propensity-score matching to reduce bias attributed to physician prescribing and practices 20 28 29. However, given that most patients were on ULT in our cohort, monitored and treated by same physician, and that the associations of UA and death were far stronger than with any individual treatment, we believe that the association between UA and mortality is robust.…”

Mounting Evidence Indicates That Escalating Doses of Allopurinol Are Unnecessary for Cardiovascular Protection: Comment on the Article by Coburn et al

“…Considering the study by Coburn et al and previous evidence, we conclude that escalating doses of allopurinol and control of uric acid using such doses are unnecessary for a cardiovascular protective effect and may be related to adverse cardiovascular outcomes.…”

“…We read with interest the recent report by Coburn et al of a methodologically sound propensity score–matched cohort study evaluating the effect of dose escalation of allopurinol on cardiovascular‐related and overall mortality. Although the results of that study indicate that increasing doses of allopurinol are associated with a higher risk of mortality, the authors comment that failure to achieve daily doses of ≥600 mg may have contributed to the absence of a protective effect.…”

Újdonságok köszvényben: patogenezis, társbetegségek, diagnosztika és terápia

“…Bizonyított, hogy enyhe-közepes vesefunkciós zavar esetén a lassan feltitrált allopurinollal könnyebben el lehet érni a kívánatos célértéket, miközben a mellékhatások gyakorisága nem változik, szemben az alacsony dózisra épülő konzervatív stratégiákkal. Az allopurinol valószínűleg kedvezően hat a társbetegségekre is [40,41]. Legújabban, 2018-ban közölték a legnagyobb mortalitási vizsgálat eredményeit.…”

“…Legújabban, 2018-ban közölték a legnagyobb mortalitási vizsgálat eredményeit. Ebben nem javította, de szignifikánsan nem is rontotta a túlélést [40].…”