Srpski arhiv za celokupno lekarstvo 2013 Volume 141, Issue 5-6, Pages: 333-336
https://doi.org/10.2298/SARH1306333R
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The efficacy and tolerability of allopurinol dose escalation in patients with gout
RadakPerović Marija (Medicinski fakultet, Beograd)
ZlatkovićŠvenda Mirjana (Institut za reumatologiju, Beograd)
Introduction. Allopurinol is still the drug of choice for the longterm
control of hyperuricemia in patients with gout. Objective. The aim of the
study was to investigate the efficacy and tolerability of different
allopurinol doses used in order to attain a target serum uric acid
concentration (SUc) of <6 mg/dl (360 µmol/L). Methods. Prospective trial was
carried out in patients with primary gout and normal renal function, no
relevant liver disease, and SUclowering treatment indications involving 12
gout episodes per year, presence of tophus and/or chronic urate arthropathy
or Xray finding of erosions. The patients were administered allopurinol in a
stepup dose scheme (beginning with 100 mg/ day then raised for 100 mg every
four weeks) until therapeutic goal was achieved or development of adverse
effects. Results. Fortyone patients were enrolled in the study; 27 end ed
it so far. The treatment target was reached in 19/27 patients using
allopurinol 300 mg/day (70.4%). After the increased dose up to 600 mg/day,
the overall treatment success was reached in 25/27 patients (92.5%). Adverse
drug reactions (ADRs) were evidenced in 12/27 patients; the most frequent
ADRs were gouty flares. The mean SUc reduction from baseline 533.9±83.4
µmol/L to 346.9±87.9 µmol/L was obtained with allopurinol at a dose of 300
mg/day (p=0.000) as well as at a dose up to 600 mg/day (274.9±92.7 µmol/L)
(p=0.000). Conclusions. Most of the investigated gouty patients attained
target SUc <360 mmol/L at a 300 mg/day allopurinol dose. However, in 30% of
patients further dose escalation up to 600 mg/day was needed but the
increased dose was well tolerated, and the therapeutic goal was achieved
even in 92.5% of patients. Such doses are in general well tolerated under the
conditions of well preserved renal function.
Keywords: gout, control of hyperuricemia, efficacy, tolerability, allopurinol