ACR Meeting Abstracts

ACR Meeting Abstracts

  • Meetings
    • ACR Convergence 2024
    • ACR Convergence 2023
    • 2023 ACR/ARP PRSYM
    • ACR Convergence 2022
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • ACR Meetings

Abstract Number: 204

The Safety and Efficacy of Allopurinol Dose Escalation in People with Gout, a Randomised Controlled Trial

Lisa K. Stamp1, Peter T. Chapman2, Murray Barclay3, Anne Horne4, Christopher Frampton1, Paul Tan5, Jill Drake6 and Nicola Dalbeth5, 1University of Otago, Christchurch, New Zealand, 2Christchurch Hospital, Christchurch, New Zealand, 3Medicine, University of Otago, Christchurch, New Zealand, 4Department of Medicine, University of Auckland, Auckland, New Zealand, 5University of Auckland, Auckland, New Zealand, 6Rheumatology, Immunology and Allergy, Christchurch Hospital, Christchurch, New Zealand

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Allopurinol, gout, safety and treatment

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print
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: Allopurinol is the most widely used urate lowering therapy. Many patients on allopurinol fail to achieve target serum urate (SU), in part due to concerns about the relationship between allopurinol dose and adverse events (AEs). The aim of this randomised controlled trial was to determine the efficacy and safety of allopurinol dose escalation using a treat to target SU approach.

Methods: An open randomised controlled trial comparing creatinine clearance (CrCL)-based allopurinol dose and allopurinol dose escalation was undertaken. Patients with gout, defined by 1977 ARA criteria, receiving at least CrCL-based allopurinol dose for ≥1 month and SU ≥6mg/dL were recruited. Severe chronic kidney disease was not an exclusion. Patients were randomised to continue current dose (control) or dose escalation (DE) for 12 months. In the DE group, allopurinol was increased monthly by 50mg-100mg/d until SU was <6mg/dL. The primary endpoint was reduction in SU and AEs coded according to Common Terminology Criteria for Adverse Events.

Results: One hundred and eighty-three participants (93 control and 90 DE) were recruited. At baseline, mean CrCL was 60 (SD 27) ml/min, urate was 7.2 (SD 1.6) mg/dL and allopurinol dose 269mg/d (range 100-600mg/d). In intention to treat analysis, mean ± SEM SU was 6.7 ± 0.2mg/dL in control participants compared to 5.7 ± 0.2mg/dL DE (p<0.001) at 12 months (Figure). SU <6mg/dL at month 12 was achieved in 32% control participants and 69% DE participants (p<0.001). During the 12-month period, 58.9% of the control group and 54.3% of the DE group experienced a gout flare (p=0.58). There were 43 serious adverse events in 25 controls and 35 events in 22 DE participants. Only one was considered probably related to allopurinol (increased INR in a DE patient on warfarin). Five control participants and 5 DE participants died; no deaths were considered allopurinol related. There were no cases of allopurinol hypersensitivity syndrome.  Eleven control participants developed rash; one was thought to be probably allopurinol related leading to allopurinol discontinuation. Eight DE participants’ developed rash; 2 were considered possibly related but settled despite continuing allopurinol and 1 was probably related and allopurinol was discontinued. Mild elevations in liver function tests were common in both groups and a few moderate increases in GGT were noted. One DE patient stopped allopurinol due to abnormal LFTs.  There was no significant difference in renal function changes between randomised groups.

Conclusion: Higher than CrCL-based doses of allopurinol can effectively lower SU in the majority of patients. Allopurinol dose escalation is well tolerated.  

 


Disclosure: L. K. Stamp, None; P. T. Chapman, None; M. Barclay, None; A. Horne, None; C. Frampton, None; P. Tan, None; J. Drake, None; N. Dalbeth, None.

To cite this abstract in AMA style:

Stamp LK, Chapman PT, Barclay M, Horne A, Frampton C, Tan P, Drake J, Dalbeth N. The Safety and Efficacy of Allopurinol Dose Escalation in People with Gout, a Randomised Controlled Trial [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/the-safety-and-efficacy-of-allopurinol-dose-escalation-in-people-with-gout-a-randomised-controlled-trial/. Accessed .
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
  • Click to print (Opens in new window) Print

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-safety-and-efficacy-of-allopurinol-dose-escalation-in-people-with-gout-a-randomised-controlled-trial/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

All abstracts accepted to ACR Convergence are under media embargo once the ACR has notified presenters of their abstract’s acceptance. They may be presented at other meetings or published as manuscripts after this time but should not be discussed in non-scholarly venues or outlets. The following embargo policies are strictly enforced by the ACR.

Accepted abstracts are made available to the public online in advance of the meeting and are published in a special online supplement of our scientific journal, Arthritis & Rheumatology. Information contained in those abstracts may not be released until the abstracts appear online. In an exception to the media embargo, academic institutions, private organizations, and companies with products whose value may be influenced by information contained in an abstract may issue a press release to coincide with the availability of an ACR abstract on the ACR website. However, the ACR continues to require that information that goes beyond that contained in the abstract (e.g., discussion of the abstract done as part of editorial news coverage) is under media embargo until 10:00 AM ET on November 14, 2024. Journalists with access to embargoed information cannot release articles or editorial news coverage before this time. Editorial news coverage is considered original articles/videos developed by employed journalists to report facts, commentary, and subject matter expert quotes in a narrative form using a variety of sources (e.g., research, announcements, press releases, events, etc.).

Violation of this policy may result in the abstract being withdrawn from the meeting and other measures deemed appropriate. Authors are responsible for notifying colleagues, institutions, communications firms, and all other stakeholders related to the development or promotion of the abstract about this policy. If you have questions about the ACR abstract embargo policy, please contact ACR abstracts staff at [email protected].

Wiley

  • Online Journal
  • Privacy Policy
  • Permissions Policies
  • Cookie Preferences

© Copyright 2025 American College of Rheumatology