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Up-titration of allopurinol in patients with gout
Jennings, Claudine G. Mackenzie, Isla S. Flynn, Rob Ford, Ian Nuki, George De Caterina, Raffaele Riches, Philip L. Ralston, Stuart H. MacDonald, Thomas M. Ralston, Stuart
Jennings, Claudine G.
Mackenzie, Isla S.
Flynn, Rob
Ford, Ian
Nuki, George
De Caterina, Raffaele
Riches, Philip L.
Ralston, Stuart H.
MacDonald, Thomas M.
Ralston, Stuart
Author
Jennings, Claudine G.
Mackenzie, Isla S.
Flynn, Rob
Ford, Ian
Nuki, George
De Caterina, Raffaele
Riches, Philip L.
Ralston, Stuart H.
MacDonald, Thomas M.
Ralston, Stuart
Findlay, Evelyn
Hallas, Jesper
Hawkey, Chris J.
Walters, Matthew
Webster, John
McMurray, John J. V.
Ruiz, Fernando Perez
Harvie, John
Mackenzie, Isla S.
Flynn, Rob
Ford, Ian
Nuki, George
De Caterina, Raffaele
Riches, Philip L.
Ralston, Stuart H.
MacDonald, Thomas M.
Ralston, Stuart
Findlay, Evelyn
Hallas, Jesper
Hawkey, Chris J.
Walters, Matthew
Webster, John
McMurray, John J. V.
Ruiz, Fernando Perez
Harvie, John
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.
Keywords
gout, allopurinol, prescribing, clinical guidelines
Date
2014
Type
Journal article
Journal
Seminars in Arthritis and Rheumatism
Book
Volume
44
Issue
1
Page Range
25-30
Article Number
ACU Department
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Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled