Does Starting Allopurinol Prolong Acute Treated Gout? A Randomized Clinical Trial

Hill, Erica M.; Sky, Karen; Sit, Michelle; Collamer, Angelique N.; Higgs, Jay B.

doi:10.1097/rhu.0000000000000235

Cited by 66 publications

(59 citation statements)

References 8 publications

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“…Two small trials have suggested that allopurinol initiation during an acute gout attack did not prolong the duration of flares nor worsen its severity as compared with delayed initiation 130 131. However, the task force considered that the low number of patients (n=51 and n=31, respectively) in these trials precluded any firm conclusions and that data obtained with allopurinol 200–300 mg could not be generalised to more potent urate-lowering drugs, such as febuxostat or a combination of XOI and an uricosuric.…”

Section: Resultsmentioning

confidence: 99%

2016 updated EULAR evidence-based recommendations for the management of gout

et al. 2016

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BACKGROUND:\ud New drugs and new evidence concerning the use of established treatments have become available since the publication of the first European League Against Rheumatism (EULAR) recommendations for the management of gout, in 2006. This situation has prompted a systematic review and update of the 2006 recommendations.\ud METHODS:\ud \ud The EULAR task force consisted of 15 rheumatologists, 1 radiologist, 2 general practitioners, 1 research fellow, 2 patients and 3 experts in epidemiology/methodology from 12 European countries. A systematic review of the literature concerning all aspects of gout treatments was performed. Subsequently, recommendations were formulated by use of a Delphi consensus approach.\ud RESULTS:\ud \ud Three overarching principles and 11 key recommendations were generated. For the treatment of flare, colchicine, non-steroidal anti-inflammatory drugs (NSAIDs), oral or intra-articular steroids or a combination are recommended. In patients with frequent flare and contraindications to colchicine, NSAIDs and corticosteroids, an interleukin-1 blocker should be considered. In addition to education and a non-pharmacological management approach, urate-lowering therapy (ULT) should be considered from the first presentation of the disease, and serum uric acid (SUA) levels should be maintained at<6 mg/dL (360 µmol/L) and <5 mg/dL (300 µmol/L) in those with severe gout. Allopurinol is recommended as first-line ULT and its dosage should be adjusted according to renal function. If the SUA target cannot be achieved with allopurinol, then febuxostat, a uricosuric or combining a xanthine oxidase inhibitor with a uricosuric should be considered. For patients with refractory gout, pegloticase is recommended.\ud CONCLUSIONS:\ud These recommendations aim to inform physicians and patients about the non-pharmacological and pharmacological treatments for gout and to provide the best strategies to achieve the predefined urate target to cure the disease

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Section: Resultsmentioning

confidence: 99%

2016 updated EULAR evidence-based recommendations for the management of gout

et al. 2016

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“…Information on duration of gout attack was only provided in one study and did not differ significantly between the allopurinol and placebo arms [17 (8.53) vs. 12.53 (7.73) days], p = 0.13 (intention to treat analysis) [7]. Authors of other studies were contacted, but were unable to provide any additional unpublished data on the duration of gout attack.…”

Section: Resultsmentioning

confidence: 99%

“…Information on pain VAS on day 10 was published in one paper [6] and was obtained by contacting the authors of another study [7]. In the latter study, pain VAS was measured between days 10 and 15 [7].…”

Section: Resultsmentioning

confidence: 99%

“…In the latter study, pain VAS was measured between days 10 and 15 [7]. On pooling the data, there was no evidence to suggest that early initiation of ULT associated with pain; however, there was substantial heterogeneity, with I 2 = 64 % (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…In the study comparing early versus delayed initiation of allopurinol, the number of patients with acute gout attacks was comparable in the early (7.7 %) and delayed (12 %) initiation arms at 28 days [6]. Only 1 patient commenced on allopurinol had a flare of acute gout in the Hill et al’s [7] study; however, the other group was only given placebo, which would not be expected to trigger acute gout. In the study by Fraser et al [5], there was one acute attack of gout in the first 28 days in those randomized to azapropazone, while there were 5 acute attacks of gout in those randomized to indomethacin.…”

Section: Resultsmentioning

confidence: 99%

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Does the initiation of urate-lowering treatment during an acute gout attack prolong the current episode and precipitate recurrent attacks: a systematic literature review

et al. 2016

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The aim of this study was to systematically review the literature on effect of initiating urate-lowering treatment (ULT) during an acute attack of gout on duration of index attack and persistence on ULT. OVID (Medline), EMBASE and AMED were searched to identify randomized controlled trials (RCTs) of ULT initiation during acute gout attack published in English language. Two reviewers appraised the study quality and extracted data independently. Standardized mean difference (SMD) and relative risk (RR) were used to pool continuous and categorical data. Meta-analysis was carried out using STATA version 14. A total of 537 studies were selected. A total of 487 titles and abstracts were reviewed after removing duplicates. Three RCTs were identified. There was evidence from two high-quality studies that early initiation of allopurinol did not increase pain severity at days 10–15 [SMDpooled (95 % CI) 0.18 (−0.58, 0.93)]. Data from three studies suggested that initiation of ULT during an acute attack of gout did not associate with dropouts [RRpooled (95 % CI) 1.16 (0.58, 2.31)]. There is moderate-quality evidence that the initiation of ULT during an acute attack of gout does not increase pain severity and risk of ULT discontinuation. Larger studies are required to confirm these findings so that patients with acute gout can be initiated on ULT with confidence.Electronic supplementary materialThe online version of this article (doi:10.1007/s00296-016-3579-z) contains supplementary material, which is available to authorized users.

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