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Predicting Gout Flares with Allopurinol
Conexiant
June 7, 2024
A recent study found that patients who experienced a gout flare before starting allopurinol 100 mg had a higher risk of future flares, highlighting the need for targeted prophylaxis.
Published in Arthritis Care & Research, researchers investigated predictors of gout flares in patients beginning allopurinol using a "start-low go-slow" dose escalation strategy. This post hoc analysis of a 12-month double-blind placebo-controlled trial included 200 participants, randomized 1:1 to receive either colchicine 0.5 mg daily or a placebo for the first six months. The study utilized multivariable logistic regression models to identify predictors of gout flares.
The results indicated that significant predictors of gout flares in the first six months included having a flare in the month before starting allopurinol (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.36-5.17) and starting allopurinol at a dose of 100 mg (OR, 3.21; 95% CI, 1.41-7.27). In the subsequent six months, predictors included having received colchicine (OR, 2.95; 95% CI, 1.48-5.86), experiencing at least one flare in the month before discontinuing the study drug (OR, 5.39; 95% CI, 2.21-13.15), and having serum urate levels ≥0.36 mmol/L at month 6 (OR, 2.85; 95% CI, 1.14-7.12).
The study suggested that anti-inflammatory prophylaxis should be targeted at patients who have experienced a recent flare and are starting on a 100 mg daily dose of allopurinol. For those with persistent flares during the initial six months without achieving serum urate targets, extended prophylaxis may be necessary.
This study was supported by the Health Research Council of New Zealand, and the authors reported no conflicts of interest.
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