However, a minority of dose-escalated patients achieved serum urate goal. Thus, inadequate escalation may have obscured any potential mortality benefit associated with the treatment strategy, the investigators suggested.
Current guidelines recommend starting gout patients on a low dose of allopurinol (100 mg/day or less) and then titrating up the dose slowly.
“While randomized, controlled trials of urate-lowering therapies have used static dosing strategies, such strategies are suboptimal and should now be considered unethical,” they wrote.
The researchers’ 10-year, observational, active-comparator study included 6,428 U.S. veterans with gout receiving allopurinol according to a dose escalation strategy, and 6,428 matched individuals not treated with an escalation approach.