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Predicting Response or Non-response to Urate-Lowering Therapy in Patients with Gout.
Curr Rheumatol Rep. 2018 06 21; 20(8):47.CR

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

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Publisher Full Text (DOI)

Authors+Show Affiliations

Graham GG
Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, NSW, Australia. School of Medical Sciences, University of New South Wales, Kensington, NSW, Australia.
Stocker SL
Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, NSW, Australia. sophie.stocker@svha.org.au. St Vincent's Clinical School, St Vincent's Hospital, University of New South Wales, Kensington, Sydney, Australia. sophie.stocker@svha.org.au.
Kannangara DRW
Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, NSW, Australia. School of Medical Sciences, University of New South Wales, Kensington, NSW, Australia. St Vincent's Clinical School, St Vincent's Hospital, University of New South Wales, Kensington, Sydney, Australia. School of Medicine, University of Notre Dame, Sydney, Australia.
Day RO
Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, NSW, Australia. School of Medical Sciences, University of New South Wales, Kensington, NSW, Australia. St Vincent's Clinical School, St Vincent's Hospital, University of New South Wales, Kensington, Sydney, Australia.

MeSH

GoutGout SuppressantsHumansTreatment OutcomeUric Acid

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

29931553

Citation

Graham, Garry G., et al. "Predicting Response or Non-response to Urate-Lowering Therapy in Patients With Gout." Current Rheumatology Reports, vol. 20, no. 8, 2018, p. 47.
Graham GG, Stocker SL, Kannangara DRW, et al. Predicting Response or Non-response to Urate-Lowering Therapy in Patients with Gout. Curr Rheumatol Rep. 2018;20(8):47.
Graham, G. G., Stocker, S. L., Kannangara, D. R. W., & Day, R. O. (2018). Predicting Response or Non-response to Urate-Lowering Therapy in Patients with Gout. Current Rheumatology Reports, 20(8), 47. https://doi.org/10.1007/s11926-018-0760-2
Graham GG, et al. Predicting Response or Non-response to Urate-Lowering Therapy in Patients With Gout. Curr Rheumatol Rep. 2018 06 21;20(8):47. PubMed PMID: 29931553.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predicting Response or Non-response to Urate-Lowering Therapy in Patients with Gout. AU - Graham,Garry G, AU - Stocker,Sophie L, AU - Kannangara,Diluk R W, AU - Day,Richard O, Y1 - 2018/06/21/ PY - 2018/6/23/entrez PY - 2018/6/23/pubmed PY - 2019/10/23/medline KW - ABCG2 KW - Allopurinol KW - Febuxostat KW - Gout KW - Serum urate KW - Uric acid SP - 47 EP - 47 JF - Current rheumatology reports JO - Curr Rheumatol Rep VL - 20 IS - 8 N2 - 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. Careful examination of medication adherence, titration of doses, and the addition of uricosuric agents increase the percentage of patients responding to allopurinol and febuxostat. SN - 1534-6307 UR - https://www.unboundmedicine.com/medline/citation/29931553/Predicting_Response_or_Non_response_to_Urate_Lowering_Therapy_in_Patients_with_Gout_ DB - PRIME DP - Unbound Medicine ER -