Impaired response or insufficient dosage? Examining the potential causes of "inadequate response" to allopurinol in the treatment of gout

Show simple item record Stamp, LK en Merriman, TR en Barclay, ML en Singh, JA en Roberts, RL en Wright, DF en Dalbeth, Nicola en
dc.coverage.spatial United States en 2015-07-24T03:06:59Z en 2014-10 en
dc.identifier.citation Seminars in Arthritis and Rheumatism, 2014, 44 (2), pp. 170 - 174 en
dc.identifier.issn 0049-0172 en
dc.identifier.uri en
dc.description.abstract OBJECTIVES: Gout is one of the most common forms of arthritis. It is well established that urate-lowering therapy that aims for a serum urate less than at least 0.36 mmol/l (6 mg/dl) is required for the successful management of gout. Allopurinol, a xanthine oxidase (XO) inhibitor, is the most commonly used urate-lowering therapy. However, many patients fail to achieve the target serum urate on allopurinol; these patients can be considered to have "inadequate response" to allopurinol. Herein, we examine the potential mechanisms and implications of inadequate response to allopurinol. METHODS: The literature was reviewed for potential causes for failure to reach target serum urate in patients receiving allopurinol. RESULTS: The two most common causes of inadequate response to allopurinol are poor adherence and under-dosing of allopurinol. Adherent patients who fail to achieve target serum urate on standard doses of allopurinol form a group that could be considered to be "partially resistant" to allopurinol. There are four potential mechanisms for partial allopurinol resistance: decreased conversion of allopurinol to oxypurinol; increased renal excretion of oxypurinol; abnormality in XO structure and/or function such that oxypurinol is rendered less effective and/or drug interactions. CONCLUSIONS: It is important to determine the reasons for failure to achieve treatment targets with allopurinol, particularly as newer agents become available. The knowledge of the mechanisms for inadequate response may help guide the clinician towards making a therapeutic choice that is more likely to result in achieving the serum urate target. en
dc.language eng en
dc.relation.ispartofseries Seminars in Arthritis and Rheumatism en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. Details obtained from en
dc.rights.uri en
dc.subject Allopurinol en
dc.subject Drug resistance en
dc.subject Gout en
dc.subject Oxypurinol en
dc.title Impaired response or insufficient dosage? Examining the potential causes of "inadequate response" to allopurinol in the treatment of gout en
dc.type Journal Article en
dc.identifier.doi 10.1016/j.semarthrit.2014.05.007 en
pubs.issue 2 en
pubs.begin-page 170 en
pubs.volume 44 en
dc.identifier.pmid 24925693 en en
pubs.end-page 174 en
dc.rights.accessrights en
pubs.subtype Journal Article en
pubs.subtype Research Support, N.I.H., Extramural en
pubs.subtype Research Support, Non-U.S. Gov't en
pubs.subtype Research Support, U.S. Gov't, P.H.S. en
pubs.subtype Article en
pubs.elements-id 443848 en Medical and Health Sciences en School of Medicine en Medicine Department en
dc.identifier.eissn 1532-866X en
dc.identifier.pii S0049-0172(14)00077-8 en
pubs.record-created-at-source-date 2015-07-24 en
pubs.dimensions-id 24925693 en

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