The following is a summary of  “Long-Term Follow-up of a Randomized Controlled Trial of Allopurinol Dose Escalation to Achieve Target Serum Urate in People With Gout” published in the December 2022 issue of Rheumatology by Coleman, et al.

The purpose of this study was to evaluate the long-term efficacy and adherence to urate-lowering therapy (ULT), serum urate (SU) control, and self-reported flares among gout patients who participated in a randomized controlled trial of allopurinol dose escalation.   A review of medical records revealed whether or not research participants who were still alive had received ULTs and had their SU levels tested within the previous 12 months. In addition, adherence and reported flares were both assessed via telephone interview.

There were 183 original enrollees, and 60 (33%) had passed away throughout the mean follow-up period of 6.5 (SD 2.5) years. Of the 119 people who made it to the end, 82% were taking allopurinol, 5% were using febuxostat, and 8% weren’t taking any ULT at all; for the other 5%, ULT use was unknown. Mean allopurinol dose was 28.1 (range, -600 to 500) mg/day lower than at the previous study visit, with 49% on the same dose, 18% on a higher dose, and 33% on a lower dose than before. Around 86 of 119 (72.5%) participants had SU values, and of those, 58.2% (50/86) had SU concentrations below more than 0.36 mmol/L. 

About  (19%) of the 89 people who took part in the phone interview said they had experienced a gout flare in the previous 12 months;  79 (89%) were taking allopurinol; and  71% (90%) of those taking allopurinol said they adhered to their treatment plan 90% or better of the time. Surviving participants in the allopurinol dose escalation study reported minimal numbers of flares and good real-world persistence with allopurinol.