Allopurinol Dose Escalation for Gout Does Not Improve Mortality

Linked to small increase in mortality; at 2 years, 31 percent of dose escalators achieved serum urate goal.
Linked to small increase in mortality; at 2 years, 31 percent of dose escalators achieved serum urate goal.

HealthDay News — Allopurinol dose escalation is not associated with reductions in mortality risk among patients with gout, according to a study published in the August issue of Arthritis & Rheumatology.

Brian W. Coburn, PhD, from the University of Nebraska Medical Center in Omaha, and colleagues assessed whether allopurinol dose escalation is associated with cause-specific mortality in patients with gout. The authors performed a 10-year observational, active-comparator study of US veterans with gout who initiated treatment with allopurinol. The study included 6428 dose escalators and 6428 matched non-escalators. 

Related Articles

The researchers found that there were 2867 deaths during the observation period. There was an increase in all-cause mortality among dose escalators (hazard ratio, 1.08; 95% confidence interval, 1.01 to 1.17). Similar effect sizes were seen for incidence of cardiovascular-related deaths (hazard ratio, 1.08; 95% confidence interval, 0.97 to 1.21) and cancer-related deaths (hazard ratio, 1.06; 95% confidence interval, 0.88 to 1.27). At 2 years, 10% of dose escalators were receiving a final daily dose of >300mg and 31% had achieved a serum urate goal of <6mg/dL.

"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," the authors write.

One author disclosed financial ties to the pharmaceutical industry.

Abstract/Full Text (subscription or payment may be required)