A randomised controlled trial of the efficacy and safety of allopurinol dose escalation to achieve target serum urate in people with gout

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dc.contributor.author Stamp, LK en
dc.contributor.author Chapman, PT en
dc.contributor.author Barclay, ML en
dc.contributor.author Horne, Anne en
dc.contributor.author Frampton, C en
dc.contributor.author Tan, P en
dc.contributor.author Drake, J en
dc.contributor.author Dalbeth, Nicola en
dc.date.accessioned 2018-11-01T20:29:40Z en
dc.date.issued 2017-03-17 en
dc.identifier.issn 0003-4967 en
dc.identifier.uri http://hdl.handle.net/2292/43728 en
dc.description.abstract To determine the efficacy and safety of allopurinol dose escalation using a treat-to-target serum urate (SU) approach.A randomised, controlled, parallel-group, comparative clinical trial was undertaken. People with gout receiving at least creatinine clearance (CrCL)-based allopurinol dose for ≥1 month and SU ≥6 mg/dL were recruited. Participants were randomised to continue current dose (control) or allopurinol dose escalation for 12 months. In the dose escalation group, allopurinol was increased monthly until SU was <6 mg/dL. The primary endpoints were reduction in SU and adverse events (AEs).183 participants (93 control, 90 dose escalation) were recruited. At baseline, mean (SD) urate was 7.15 (1.6) mg/dL and allopurinol dose 269 mg/day. 52% had CrCL<60 mL/min. Mean changes in SU at the final visit were -0.34 mg/dL in the control group and -1.5 mg/dL in the dose escalation group (p<0.001) with a mean difference of 1.2 mg/dL (95% CI 0.67 to 1.5, p<0.001). At month 12, 32% of controls and 69% in the dose escalation had SU <6 mg/dL. There were 43 serious AEs in 25 controls and 35 events in 22 dose escalation participants. Only one was considered probably related to allopurinol. Five control and five dose escalation participants died; none was considered allopurinol related. Mild elevations in LFTs were common in both groups, a few moderate increases in gamma glutamyl transferase (GGT) were noted. There was no difference in renal function changes between randomised groups.Higher than CrCL-based doses of allopurinol can effectively lower SU to treatment target in most people with gout. Allopurinol dose escalation is well tolerated.ANZCTR12611000845932; Results. en
dc.format.medium Print-Electronic en
dc.language eng en
dc.publisher BMJ Publishing Group en
dc.relation.ispartofseries Annals of the Rheumatic Diseases 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.title A randomised controlled trial of the efficacy and safety of allopurinol dose escalation to achieve target serum urate in people with gout en
dc.type Journal Article en
dc.identifier.doi 10.1136/annrheumdis-2016-210872 en
pubs.issue 9 en
pubs.begin-page 1522 en
pubs.volume 76 en
dc.rights.holder Copyright: The author en
dc.identifier.pmid 28314755 en
pubs.end-page 1528 en
dc.rights.accessrights http://purl.org/eprint/accessRights/RestrictedAccess en
pubs.subtype Article en
pubs.elements-id 619754 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 1468-2060 en
pubs.record-created-at-source-date 2017-06-29 en
pubs.dimensions-id 28314755 en

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