Allopurinol dosage reductions in patients hospitalized with acute gout are associated with an increased risk for gout flares within 3 months of discharge compared with no changes in dosage, according to study findings published in the Journal of Rheumatology.

Irvin J. Huang, DO, of the University of Washington in Seattle, Washington and colleagues studied 59 patients who had a diagnosis of gout and active prescriptions for allopurinol who were hospitalized for acute gout flares. The study population had a median age of 58 years, and 92% of patients were male.

The 59 patients had a total of 73 hospitalizations. Allopurinol was either reduced or discontinued in 15 admissions (allopurinol-reduced group), whereas the drug was increased or unchanged during the other 58 admissions (comparator group).

The proportion of patients with chronic kidney disease (CKD) was similar between the groups, but the allopurinol-reduced group had a greater proportion of patients with acute kidney injury vs the comparator group (60% vs 36%). The allopurinol-reduced group had a significantly higher rate of gout flares within 3 months of discharge vs the comparator group (53% vs 22%).


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The authors noted that dose reduction in their study was driven primarily by concerns that allopurinol use in patients with gout flares and renal insufficiency can worsen renal function and increase the risk of allopurinol hypersensitivity syndrome. They pointed out, however, that current studies support the safety of allopurinol use for gout patients with concurrent renal insufficiency. “Improved awareness of the current gout recommendations, as well as the risks and benefits of allopurinol in the setting of concomitant renal disease, is necessary to improve patient outcomes,” they wrote.

Reference

Huang IJ, Bays AM, Liew JW. Frequency of allopurinol dose reduction in hospitalized patients with gout flares. Published online October 15, 2020. J Rheumatol.

doi:10.3899/jrheum.201142