PMID- 28830881
OWN - NLM
STAT- MEDLINE
DCOM- 20171127
LR  - 20171128
IS  - 1468-2060 (Electronic)
IS  - 0003-4967 (Linking)
VI  - 76
IP  - 12
DP  - 2017 Dec
TI  - Allopurinol dose escalation to achieve serum urate below 6 mg/dL: an open-label 
      extension study.
PG  - 2065-2070
LID - 10.1136/annrheumdis-2017-211873 [doi]
AB  - OBJECTIVES: To determine the long-term safety and efficacy of allopurinol dose 
      escalation (DE) to achieve target serum urate (SU) in gout. METHODS: People, 
      including those with chronic kidney disease, who completed the first 12 months of 
      a randomised controlled trial continued into a 12-month extension study. 
      Participants randomised to continue current dose for the first 12 months began 
      allopurinol DE at month 12 if SU was >/=6 mg/dL (control/DE). Immediate DE 
      participants who achieved target SU maintained allopurinol dose (DE/DE). The 
      primary endpoints were reduction in SU and adverse events (AEs) at month 24. 
      RESULTS: The mean (SE) change in SU from month 12 to 24 was -1.1 (0.2) mg/dL in 
      control/DE and 0.1 (0.2) mg/dL in DE/DE group (p<0.001). There was a significant 
      reduction in the percentage of individuals having a gout flare in the month prior 
      to months 12 and 24 compared with baseline in both groups and in mean tophus size 
      over 24 months, but no difference between randomised groups. There were similar 
      numbers of AEs and serious adverse events between groups. CONCLUSIONS: The 
      majority of people with gout tolerate higher than creatinine clearance-based 
      allopurinol dose and achieve and maintain target SU. Slow allopurinol DE may be 
      appropriate in clinical practice even in those with kidney impairment. TRIAL 
      REGISTRATION NUMBER: ACTRN12611000845932.
CI  - (c) Article author(s) (or their employer(s) unless otherwise stated in the text of 
      the article) 2017. All rights reserved. No commercial use is permitted unless 
      otherwise expressly granted.
FAU - Stamp, Lisa K
AU  - Stamp LK
AD  - Department of Medicine, University of Otago, Christchurch, New Zealand.
AD  - Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, 
      Christchurch, New Zealand.
FAU - Chapman, Peter T
AU  - Chapman PT
AD  - Department of Rheumatology, Immunology and Allergy, Christchurch Hospital, 
      Christchurch, New Zealand.
FAU - Barclay, Murray
AU  - Barclay M
AD  - Department of Medicine, University of Otago, Christchurch, New Zealand.
FAU - Horne, Anne
AU  - Horne A
AD  - Department of Medicine, University of Auckland, Auckland, New Zealand.
FAU - Frampton, Christopher
AU  - Frampton C
AD  - Department of Medicine, University of Otago, Christchurch, New Zealand.
FAU - Tan, Paul
AU  - Tan P
AD  - Department of Medicine, University of Auckland, Auckland, New Zealand.
FAU - Drake, Jill
AU  - Drake J
AD  - Department of Medicine, University of Otago, Christchurch, New Zealand.
FAU - Dalbeth, Nicola
AU  - Dalbeth N
AD  - Department of Medicine, University of Auckland, Auckland, New Zealand.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20170822
PL  - England
TA  - Ann Rheum Dis
JT  - Annals of the rheumatic diseases
JID - 0372355
RN  - 0 (Gout Suppressants)
RN  - 268B43MJ25 (Uric Acid)
RN  - 63CZ7GJN5I (Allopurinol)
SB  - IM
MH  - Aged
MH  - Allopurinol/*administration & dosage
MH  - Dose-Response Relationship, Drug
MH  - Female
MH  - Gout/*blood/*drug therapy
MH  - Gout Suppressants/*administration & dosage
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Time Factors
MH  - Treatment Outcome
MH  - Uric Acid/*blood
OTO - NOTNLM
OT  - allopurinol
OT  - gout
OT  - serum urate
COIS- Competing interests: LKS reports grants from Health Research Council of New 
      Zealand during the conduct of the study; grants from Ardea Biosciences; grants 
      from Health Research Council of New Zealand, outside the submitted work. AH 
      reports grants from Health Research Council of New Zealand during the conduct of 
      the study. ND reports grants from Health Research Council of New Zealand during 
      the conduct of the study; grants and personal fees from AstraZeneca and Ardea 
      Biosciences; personal fees fromTakeda, Teijin and Menarini; grants from Fonterra; 
      personal fees from Pfizer, Crealta and Cymabay, outside the submitted work. PTC, 
      MB, CF, JD and PT have nothing to disclose.
EDAT- 2017/08/24 06:00
MHDA- 2017/11/29 06:00
CRDT- 2017/08/24 06:00
PHST- 2017/06/01 00:00 [received]
PHST- 2017/07/19 00:00 [revised]
PHST- 2017/08/10 00:00 [accepted]
PHST- 2017/08/24 06:00 [pubmed]
PHST- 2017/11/29 06:00 [medline]
PHST- 2017/08/24 06:00 [entrez]
AID - annrheumdis-2017-211873 [pii]
AID - 10.1136/annrheumdis-2017-211873 [doi]
PST - ppublish
SO  - Ann Rheum Dis. 2017 Dec;76(12):2065-2070. doi: 10.1136/annrheumdis-2017-211873. 
      Epub 2017 Aug 22.