One review article written by Hazard et al published in Eur J Clin Pharmacol in 2020 reported the lack of evidence on allopurinol use to prevent the first gout attack among persons with asymptomatic hyperuricemia [1]. Some of our ideas are shared with the readers.

In order to support Hazard et al.’s comments, a preliminary case-control study was performed to explore the association between the first gout attack and allopurinol use by analyzing the 2004–2012 database of the Taiwan National Health Insurance Program with covering 99.7% of 23 million persons living in Taiwan [2]. Persons ages 20 to 84 years who had the first gout attack were assigned as the case group based on International Classification of Diseases, Ninth Revision code. For every person with the first gout attack, 4 sex-matched and age-matched persons without the diagnosis of any gout attack were selected as the control group. Table 1 reveals that the odds of allopurinol use among cases with the first gout attack were significantly higher than the odds of allopurinol use among controls (crude odds ratio = 7.16, 95% confidence interval = 6.11–8.39; P < 0.001). This result indicates that allopurinol use could not prevent the first gout attack. This result partially explains the lack of evidence on allopurinol use to prevent the first gout attack among persons with asymptomatic hyperuricemia [1]. More real-world data are needed to explore whether other uric acid-lowing agents can be used to prevent the first gout attack among persons with asymptomatic hyperuricemia.

Table 1 Association between the first gout attack and allopurinol use among persons ages 20–84 in a case-control study from 2004 to 2012
Full size table