BOSTON – Despite fears of a rare but potentially fatal adverse reaction with use of allopurinol, the drug modestly reduces risk of death in patients with hyperuricemia and gout, according to a recent study.
The article, published recently in The Annals of the Rheumatic Diseases, noted that gout itself has been associated with an increased risk of premature death and that the rare reaction to allopurinol, which can lead to death, affects only about 1 in 260 allopurinol users. Despite reluctance among some physicians to prescribe the drug because of the possiblity of severe skin reactions, it remains one of the most widely prescribed for gout.1
The study group, including researchers from the Boston VAMC, used The Health Improvement Network database, which contains computerized medical records entered by general practitioners in the United Kingdom, to evaluate the effect of starting allopurinol on the risk of death among patients who had high uric acid or a diagnosis of gout. Study subjects were 40 years old and older and had received treatment between January 200 and May 2010, about 84% of them for gout.
Results indicated that, of 5,927 allopurinol initiators and 5,927 matched comparators, 654 and 718, respectively, died during the follow-up average 2.9 years.
“Allopurinol initiation was associated with a lower risk of all-cause mortality (matched HR 0.89 (95% CI 0.80-0.99)),” according to the report. “When we limited the analysis to those with gout, the corresponding HR was 0.81 (95% CI 0.70-0.92).”
Study authors suggested that the “overall benefit of allopurinol on survival may outweigh the impact of rare serious adverse effects.”
“We found that allopurinol initiation was associated with an 11% lower risk of all-cause mortality compared with non-initiators in hyperuricemic patients and a 19 percent lower risk of mortality in gout patients,” explained lead author Maureen Dubreuil, MD, of Boston University School of Medicine. “These risk reductions were apparent from the first year and throughout the subsequent years of follow-up.”
Dubreuil said the research is important because it shows that treatment with allopurinol may not only treat gout, but it may protect gout patients from premature death.
1Dubreuil M, Zhu Y, Zhang Y, Seeger JD, Lu N, Rho YH, Choi HK. Allopurinol initiation and all-cause mortality in the general population. Ann Rheum Dis. 2014 Mar 24. doi: 10.1136/annrheumdis-2014-205269. [Epub ahead of print] PubMed PMID: 24665118.
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