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Predicting Response or Non-response to Urate-Lowering Therapy in Patients with Gout

  • Garry G. Graham
  • Sophie L. Stocker
  • Diluk R.W. Kannangara
  • Richard O. Day
Crystal Arthritis (L Stamp, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Crystal Arthritis

Abstract

Purpose of Review

To review the extent of treatment success or failure with the xanthine oxidoreductase inhibitors allopurinol and febuxostat and indicate how the dosage of urate-lowering therapy (ULT) may be modified to increase the response in the majority of patients with gout.

Recent Findings

Gout flares are associated with serum concentrations of urate above 0.42 mmol/L (7 mg/dL). Achieving and maintaining serum urate below 0.36 mmol/L is considered an effective response to ULT. On an intention to treat basis, clinical trials indicate that allopurinol at daily doses of 100 to 300 mg decreases serum urate adequately in only about 40% of gout patients while febuxostat 80 mg daily reduces serum urate adequately in approximately 70% of gout patients. Higher doses of ULT may be required in patients receiving concomitant diuretics. The addition of a uricosuric agent to allopurinol and febuxostat therapy significantly increases the proportion of patients achieving adequate lowering of serum urate. Finally, carriers of a genetic variant of the transporter, ABCG2 (BCRP), have a decreased response to allopurinol.

Summary

Careful examination of medication adherence, titration of doses, and the addition of uricosuric agents increase the percentage of patients responding to allopurinol and febuxostat.

Keywords

Allopurinol Febuxostat Uric acid Serum urate Gout ABCG2 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Garry G. Graham
    • 1
    • 2
  • Sophie L. Stocker
    • 1
    • 3
  • Diluk R.W. Kannangara
    • 1
    • 2
    • 3
    • 4
  • Richard O. Day
    • 1
    • 2
    • 3
  1. 1.Department of Clinical Pharmacology & ToxicologySt Vincent’s HospitalSydneyAustralia
  2. 2.School of Medical SciencesUniversity of New South WalesKensingtonAustralia
  3. 3.St Vincent’s Clinical School, St Vincent’s HospitalUniversity of New South WalesKensingtonAustralia
  4. 4.School of MedicineUniversity of Notre DameSydneyAustralia

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