Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2024 Oct;76(10):1371-1378.
doi: 10.1002/acr.25376. Epub 2024 Jun 5.

Predicting Gout Flares in People Starting Allopurinol Using the Start-Low Go-Slow Dose Escalation Strategy

Lisa K Stamp  1 , Anne Horne  2 , Borislav Mihov  2 , Jill Drake  3 , Janine Haslett  3 , Peter Chapman  4 , Christopher Frampton  3 , Nicola Dalbeth  5
Affiliations
Randomized Controlled Trial

Predicting Gout Flares in People Starting Allopurinol Using the Start-Low Go-Slow Dose Escalation Strategy

Lisa K Stamp et al. Arthritis Care Res (Hoboken). 2024 Oct.

Abstract

Objective: The study objective was to determine predictors of gout flare when commencing allopurinol using the "start-low go-slow" dose escalation strategy.

Methods: A post hoc analysis of a 12-month double-blind placebo-controlled noninferiority trial with participants randomized 1:1 to colchicine 0.5 mg daily or placebo for the first six months was undertaken. Multivariate logistic regression models were used to identify independent predictors of gout flares in the first and last six months of the trial.

Results: Multivariable analysis revealed a significant association between risk of a gout flare in the first six months and flare in the month before starting allopurinol (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.36-5.17) and allopurinol 100 mg starting dose (OR 3.21, 95% CI 1.41-7.27). The predictors of any gout flares in the last six months of the trial, after stopping colchicine or placebo, were having received colchicine (OR 2.95, 95% CI 1.48-5.86), at least one flare in the month before stopping study drug (OR 5.39, 95% CI 2.21-13.15), and serum urate ≥0.36 mmol/L at month 6 (OR 2.85, 95% CI 1.14-7.12).

Conclusion: Anti-inflammatory prophylaxis when starting allopurinol using the "start-low go-slow" dose escalation strategy may be best targeted at those who have had a gout flare in the month before starting allopurinol and are commencing allopurinol 100 mg daily. For those with ongoing gout flares during the first six months of starting allopurinol who have not yet achieved serum urate target, a longer period of prophylaxis may be required.

PubMed Disclaimer

References

REFERENCES

    1. Tatlock S, Rüdell K, Panter C, et al. What outcomes are important for gout patients? In‐depth qualitative research into the gout patient experience to determine optimal endpoints for evaluating therapeutic interventions. Patient 2017;10(1):65–79.
    1. Singh JA. Research priorities in gout: the patient perspective. J Rheumatol 2014;41(3):615–616.
    1. Stewart S, Guillen AG, Taylor WJ, et al. The experience of a gout flare: a meta‐synthesis of qualitative studies. Semin Arthritis Rheum 2020;50(4):805–811.
    1. Stamp LL, Frampton C, Morillon MB, et al. Association between serum urate and flares in people with gout and evidence for surrogate status: a secondary analysis of two randomised controlled trials. Lancet Rheumatol 2022;4(1):e53–e60.
    1. FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res (Hoboken) 2020;72(6):744–760.

Publication types

LinkOut - more resources