ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 179

Effect of Allopurinol on All-Cause Mortality in Adults with Incident Gout: Propensity Score Matched Landmark Analysis

Chang-Fu Kuo1,2, Matthew J. Grainge3, Christian Mallen4, Weiya Zhang1 and Michael Doherty5, 1Academic Rheumatology, School of Clinical Sciences, University of Nottingham, Nottingham, United Kingdom, 2Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taipei, Taiwan, 3Division of Epidemiology and Public Health, School of Community Health Sciences,, University of Nottingham, Nottingham, United Kingdom, 4Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom, 5Division of Rheumatology, Orthopedics and Dermatology, University of Nottingham, Nottingham, United Kingdom

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Metabolic and Crystal Arthropathies: Clinical Aspects

Session Type: Abstract Submissions (ACR)

Background/Purpose

Although current guidelines recommend allopurinol as a first-line urate-lowering treatment for gout patients, whether the balance of potential benefits and risks can translate to any influence on survival in gout patients remains unclear. The objective of this study was to examine the association between allopurinol use and all-cause mortality for patients with incident gout.

Methods

This study was conducted using the UK Clinical Practice Research Data-link. Patients were included if they were aged 20 years or older, were given first ever gout diagnosis between 1995 and 1999, and had no evidence of gout or prescription for ULT prior to the time of diagnosis. We used propensity score matched landmark analysis to compared incident gout patients who received allopurinol for at least 6 months within exposure window and those did not for all-cause mortality.

Results

Of 23,332 incident gout patient identified, the propensity-matched cohorts contained 1,016 patients exposed to allopurinol on the date one year from diagnosis (landmark date) and 1,016 allopurinol non-users. They were significantly older and had more comorbidity and multiple medications than the overall incident gout patients. Over a median follow-up period of 10 years after the landmark date, there were 437 allopurinol users and 443 allopurinol non-users who died during follow-up. Allopurinol users and non-users had similar risk for all-cause mortality (hazard ratios 0.99; 95% confidence interval. 0.87─1.12). In the three-year landmark analysis, 3,519 allopurinol users (1,280 died) were compared with 3,519 non-users (1,265 died). The hazard ratio for all-cause mortality was 1.01 (95% confidence interval 0.92─1.09). 

Conclusion

This propensity score matched landmark analysis in a population of incident gout patients in the UK primary care setting found a neutral effect on the risk of all-cause mortality. Our study provides reassurance for prescription of allopurinol in gout patients early in their disease course to prevent untoward consequences of chronic uncontrolled hyperuricaemia.

Disclosure:

C. F. Kuo,
None;

M. J. Grainge,
None;

C. Mallen,
None;

W. Zhang,
None;

M. Doherty,

Manarini,

5.

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