Background/Purpose:

The discontinuation of urate-lowering therapy (ULT) in the outpatient setting increases the risk of gout flare. It was reported that in hospitalized patients with gout flare in almost a quarter of admissions allopurinol was discontinued or decreased on day of admission. We have reviewed the hospitalizations of patients with a history of gout presenting to our hospital for conditions other than gout. The aim of the study was to determine if there was an association between the discontinuation of allopurinol upon admission to the hospital and the risk of developing a gout flare during hospitalization.

Methods:

This was a retrospective chart review of patients with a history of gout, on chronic ULT with allopurinol, who were admitted to our hospital for conditions other than gout from 03/01/2017 – 03/31/2019. We only included patients hospitalized for at least 2 days. Charts were reviewed for patient demographics, length of stay, allopurinol discontinuation, gout flare, and corresponding risk factors. Data were summarized using descriptive statistics for baseline characteristics and outcomes. Inferential statistics were performed where appropriate to compare patients with and without continued allopurinol treatment during hospitalization. All p-values were two-tailed and a level of < 0.05 was considered significant.

Results:

A total of 401 patients with a history of gout and allopurinol listed as an outpatient medication on the day of admission were included in the study. The mean age of the included population was 75+/- 13 years old (ranging between 40 and 99 years old). The majority of included patients were males (296 subjects comprising 74% of the population). The mean length of stay (LOS) was 6.29 days (ranging between 2 and 57 days). Most of the patients were obese with the mean body mass index (BMI) of 30 kg/m2 (17-61 kg/m2 ). The baseline characteristics (age, gender, BMI, use of loop and thiazide diuretics, history of renal failure, smoking status) of no-allopurinol (allopurinol discontinued on admission) and yes-allopurinol (allopurinol continued on admission) groups were not significantly different between the two groups. 23.3% (7/30) of patients who had allopurinol discontinued on admission (no-allopurinol group) developed gout flare during hospitalization. In contrast, only 2.2% (8/371) of patients in the yes-allopurinol group developed gout flare during hospitalization. The odds of having gout flare in the no-allopurinol group were significantly higher than in the yes-allopurinol group (Fisher exact probability test OR 13.8, CI 4.6 – 41.4, p=< 0.0001). In our study, the LOS was not affected by the development of gout flare during hospitalization (6.2 vs 6.3 days, respectively).

Conclusion:

Hospitalized patients who have allopurinol discontinued upon admission are almost 14 times more likely to develop gout flare than those patients in whom allopurinol is continued during their hospital stay. Medication reconciliation remains an important step in providing care to hospitalized patients. Understanding the role of continuation of ULT in the inpatient setting is of paramount importance in decreasing the risk of gout flare in hospitalized patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-discontinuation-of-allopurinol-in-the-inpatient-setting-and-the-risk-of-gout-flare-a-community-hospital-experience/