Session Information
Date: Sunday, November 13, 2016
Title: Metabolic and Crystal Arthropathies - Poster I: Clinical Practice
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: To assess whether allopurinol use reduces the risk of ventricular tachycardia in the elderly.
Methods: We used the 2006-2012 5% random sample of Medicare beneficiary cohort to study the association of new allopurinol initiation and the risk of incident ventricular tachycardia. Multivariable-adjusted Cox regression models adjusted for age, gender, race, and Charlson index, in addition to various cardio-protective medications (beta-blockers, ACE inhibitors, diuretics, statins). We calculated hazards ratio (HR) with 95% confidence intervals (CI).
Results: 2,665 of the 40,004 episodes of incident allopurinol use were associated with incident ventricular tachycardia (6.7% episodes). Allopurinol use was associated with reduced hazards of ventricular tachycardia, with unadjusted HR of 0.84 (95% CI, 0.77 to 0.91); multivariable-adjusted HR 0.81 (95% CI, 0.74 to 0.87) (Table 1). Compared to no allopurinol use, longer allopurinol use durations were associated with lower HR of ventricular tachycardia: 181-365 days, 0.77 (95% CI, 0.67 to 0.89); 1 to 2 years, 0.85 (95% CI, 0.73 to 0.98); and >2 years, 0.75 (95% CI, 0.62 to 0.90). Other factors associated with higher hazard of ventricular tachycardia were: age 75-<85 and ≥85, male gender, higher Charlson index score, and the use of beta blockers. Allopurinol dose was also significant in univariate analysis but not in the multivariate analysis (Table 2).
Conclusion: Incident allopurinol use was associated with a reduction in the risk of incident ventricular tachycardia; allopurinol dose was not. Longer allopurinol use durations reduced the risk of incident ventricular tachycardia incrementally. Future studies need to assess underlying mechanisms of this association and to assess risk-benefit ratio of allopurinol use for ventricular tachycardia prevention. Table 1: Univariate and multivariate adjusted hazard ratios for ventricular tachycardia based on allopurinol use.
| Unadjusted HR (95% CI) [p-value] | Multivariable-adjusted HR (95% CI) [p-value] | |
| Allopurinol use- ref, no | ||
| Yes | 0.84 (0.77, 0.91) [p<0.0001] | 0.81 (0.74, 0.87) [p<0.0001] |
Table 2: Univariate and multivariate adjusted hazard ratios for ventricular tachycardia based on allopurinol dose and duration.
| Unadjusted HR (95% CI) [p-value] | Multivariable-adjusted HR (95% CI) [p-value] | |
| Allopurinol dose use1 | ||
| <200 mg/day | ref | ref |
| 200-299 mg/day | 0.85 (0.74, 0.98) [p=0.02] | 0.90 (0.78, 1.03) [p=0.12] |
| >300 mg/day | 0.79 (0.71, 0.88) [p<0.0001] | 0.93 (0.83, 1.04) [p=0.21] |
| Allopurinol use duration | ||
| 0 days | ref | ref |
| 1-180 days | 0.91 (0.81, 1.03) [p=0.13] | 0.92 (0.81, 1.05) [p=0.23] |
| 181 days -2 years | 0.81 (0.72, 0.90) [p=0.0001] | 0.80 (0.71, 0.90) [p=0.0002] |
| >2 years | 0.75 (0.62, 0.90) [p=0.0021] | 0.76, (0.63, 0.93) [p=0.0067] |
To cite this abstract in AMA style:
Singh JA, Cleveland J. Allopurinol Use and the Risk of Ventricular Tachycardia in the US Elderly: A Study of Medicare Claims Data [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/allopurinol-use-and-the-risk-of-ventricular-tachycardia-in-the-us-elderly-a-study-of-medicare-claims-data/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/allopurinol-use-and-the-risk-of-ventricular-tachycardia-in-the-us-elderly-a-study-of-medicare-claims-data/