Up-titration of allopurinol in patients with gout

Jennings, C. G., Mackenzie, I. S., Flynn, R., Ford, I. , Nuki, G., De Caterina, R., Riches, P. L., Ralston, S. H., MacDonald, T. M. and McMurray, J. (2014) Up-titration of allopurinol in patients with gout. Seminars in Arthritis and Rheumatism, 44(1), pp. 25-30. (doi:10.1016/j.semarthrit.2014.01.004)

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Abstract

Objectives: European League against Rheumatism (EULAR) gout management guidelines recommend achieving a target urate level <6.0 mg/dL (<357 µmol/L). Allopurinol is the most widely used urate-lowering therapy; however, many gout patients who are prescribed allopurinol do not have urate levels optimally controlled. The objective of this analysis was to review the efficacy and tolerability of allopurinol up-titration in achieving the EULAR target levels. Method: The Febuxostat versus Allopurinol Streamlined Trial (FAST) is an ongoing multi-centre study comparing the cardiovascular safety of febuxostat and allopurinol (target recruitment: 5706 patients). Recruited patients were already taking allopurinol and the protocol required up-titration of daily allopurinol dose, in 100 mg increments, to achieve the EULAR urate target level prior to randomisation. We reviewed pre-randomisation data from the first 400 recruited and subsequently randomised FAST patients. Results: Of 400 patients, 144 (36%) had urate levels ≥357 µmol/L at screening and required allopurinol up-titration. Higher urate levels were significantly associated with lower allopurinol dose, male sex, increased BMI, increased alcohol intake and diuretic use. Mean fall in urate levels after a single 100-mg dose increase was 71 µmol/L. The number of up-titrations required ranged from one to five (median = 1) with 65% of patients controlled after one 100-mg up-titration. Overall, 97% of up-titrated patients achieved target urate levels with median final allopurinol dose of 300 mg daily. Side effects and complications of up-titration were minimal. Conclusion: Overall, 36% of FAST patients were not at target urate levels and required up-titration. Allopurinol up-titration was effective in achieving urate target levels and was generally well tolerated by patients.

Item Type:Articles
Additional Information:FAST Study Group.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McMurray, Professor John and Ford, Professor Ian
Authors: Jennings, C. G., Mackenzie, I. S., Flynn, R., Ford, I., Nuki, G., De Caterina, R., Riches, P. L., Ralston, S. H., MacDonald, T. M., and McMurray, J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:Seminars in Arthritis and Rheumatism
Publisher:Elsevier
ISSN:0049-0172
ISSN (Online):1532-866X

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