Combination urate-lowering therapy in the treatment of gout: What is the evidence?

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dc.contributor.author Perez-Ruiz, Fernando en
dc.contributor.author Dalbeth, Nicola en
dc.date.accessioned 2018-10-17T03:22:19Z en
dc.date.issued 2019-02 en
dc.identifier.issn 0049-0172 en
dc.identifier.uri http://hdl.handle.net/2292/42596 en
dc.description.abstract BACKGROUND:Combination therapy that includes a uricosuric and xanthine oxidase inhibitor (XOI) is recommended in guidelines for patients with gout who do not meet treatment targets with XOI monotherapy alone. While the use of combination therapies has been investigated for many years, we reviewed data from the published studies to investigate the efficacy and safety of this approach. METHODS:Relevant published papers were identified by keyword search on PubMed and categorized according to the types of combination therapies included. Study methods and results were summarized. Outcomes of combination therapy were compared with respective monotherapies, where possible. RESULTS:Efficacy was assessed by changes in serum urate (sUA), urinary uric acid, gout flare rates, and /or tophi. Safety assessments, where reported, included adverse events and, for more recent studies, laboratory assessments. Early studies in the 1960s based on case reports or open-label designs and more recent, well-designed studies with large patient numbers provided consistent outcomes: that combination therapy with a uricosuric and a XOI provides substantially greater sUA lowering than achieved by either monotherapy. Greater sUA lowering translated to greater gout symptom control, including improved tophus resolution. CONCLUSIONS:Combination therapy with a uricosuric and an XOI offers additional sUA lowering compared to monotherapy alone and can provide benefit for achieving therapeutic targets in patients with gout who do not achieve target sUA or are intolerant of XOIs at appropriate monotherapy dosing. en
dc.format.medium Print-Electronic 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. en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.subject Humans en
dc.subject Gout en
dc.subject Uric Acid en
dc.subject Gout Suppressants en
dc.subject Treatment Outcome en
dc.subject Drug Therapy, Combination en
dc.title Combination urate-lowering therapy in the treatment of gout: What is the evidence? en
dc.type Journal Article en
dc.identifier.doi 10.1016/j.semarthrit.2018.06.004 en
pubs.issue 4 en
pubs.begin-page 658 en
pubs.volume 48 en
dc.rights.holder Copyright: The author en
pubs.end-page 668 en
pubs.publication-status Published en
dc.rights.accessrights http://purl.org/eprint/accessRights/RestrictedAccess en
pubs.subtype Research Support, Non-U.S. Gov't en
pubs.subtype Review en
pubs.subtype Journal Article en
pubs.elements-id 751385 en
pubs.org-id Medical and Health Sciences en
pubs.org-id School of Medicine en
pubs.org-id Medicine Department en
dc.identifier.eissn 1532-866X en
pubs.record-created-at-source-date 2018-08-05 en
pubs.dimensions-id 30075988 en


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